BP Chapter 6 Flashcards
what’s considered low birth weight?
2500 grams
what are the RFs for PTL?
preterm rupture of membranes chorioamnionitis multiple gestations uterine anomalies previous preterm delivery maternal prepregnancy weight less than 50 kg placental abruption maternal disease including preeclampsia, infections, intra-abdominal disease or surgery low socioeconomic status.
What are tocolytics?
medications to prolong gestation by 48 hours
goal is to halt or decrease the cervical change
Ritodrine - beta mimetic agent
What are absolute indications to continue labor?
chorioamionitis
nonreassuirng fetal testing
significant placental abruption
How are ritodrine and terbutaline given?
R - continuous
T - bolus and maintenance
black box: T can’t be given beyond 24-48 hours
AEs: tachycardia, headaches, anxiety, pulmonary edema, maternal death.
What sx should lead you to r/o ROM?
gush of fluid from vagina, stress incontinence, increased discharge
What abx is given for PPROM?
ampicillin with or w/o erythromycin
What is the obstetric conjugate?
distance between the sacral promontory and the midpoint of the symphysis pubis, and the shortest anteroposterior diameter of the pelvic inlet
What factors are associated with breech presentation?
previous breech delivery uterine anomalies polyhydramnios oligohydramnios multiple gestations PPROM hydrocephaly anencephaly
Persistent breech presentation is also associated with placenta previa and fetal anomalies
What are the complications of breech delivery for the fetus?
cord prolapse, entrapment of the fetal head, and fetal neurologic injury
What are relative CIs to attempted vaginal delivery of a breech baby?
nulliparity
fetal weight greater than 3800 grams
incomplete breech presentation
what is compound presentation
A fetal extremity presenting alongside the vertex or breech
The rate increases with prematurity, multiple gestations, polyhydramnios, and CPD
A common complication of compound presentation is umbilical cord prolapse
A persistent OT position leading to arrest of labor is more common in women with a _____.
platypelloid pelvis
What’s considered prolonged deceleration? bradycardia?
below 100 for 2 minutes
below 100 for 10 minutes
how do you treat tetanic uterine contractions?
nitroglycerin or terbutaline
What are the RFs for shoulder dystocia?
fetal macrosomia, preconceptional and gestational diabetes, previous shoulder dystocia, maternal obesity, postterm pregnancy, prolonged second stage of labor, and operative vaginal delivery.
What fetal complications are associated with shoulder dystocia?
fractures of the humerus and clavicle, brachial plexus nerve injuries (Erb palsy), phrenic nerve palsy, hypoxic brain injury, and death.
What maneuvers are used in shoulder dystocia?
- McRoberts maneuver—sharp flexion of the maternal hips that decreases the inclination of the pelvis increasing the AP diameter can free the anterior shoulder
- Suprapubic pressure—pressure applied just above the maternal pubic symphysis at an oblique angle to dislodge the anterior shoulder from behind the pubic symphysis
- Rubin maneuver—pressure on an either accessible shoul- der toward the anterior chest wall of the fetus to decrease the bisacromial diameter and free the impacted shoulder
- Wood’s corkscrew maneuver—pressure behind the posterior shoulder to rotate the infant and dislodge the anterior shoulder.
- Delivery of the posterior arm/shoulder—delivery of the posterior arm by sweeping the posterior arm across the chest to allow the bisacromial diameter to rotate to an oblique diameter of the pelvis and the anterior shoulder to be freed
- Generous episiotomy
- Zavanelli maneuver - placing infant back into uterus and doing c/s
- Symphysiotomy - cut mother’s pubic symphysis
the risk of uterine rupture increases with
patients who have more than one cesarean scar, have a “classical” or high vertical scar, undergo labor induction, and/or are treated with uterotonic agents
How do you distinguish between a seizure and a vasovagal event?
post octal state
