BP Chapter 6

Question 1

what’s considered low birth weight?

Answer 1

2500 grams

Question 2

what are the RFs for PTL?

Answer 2

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.

Question 3

What are tocolytics?

Answer 3

medications to prolong gestation by 48 hours
goal is to halt or decrease the cervical change

Ritodrine - beta mimetic agent

Question 4

What are absolute indications to continue labor?

Answer 4

chorioamionitis
nonreassuirng fetal testing
significant placental abruption

Question 5

How are ritodrine and terbutaline given?

Answer 5

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.

Question 6

What sx should lead you to r/o ROM?

Answer 6

gush of fluid from vagina, stress incontinence, increased discharge

Question 7

What abx is given for PPROM?

Answer 7

ampicillin with or w/o erythromycin

Question 8

What is the obstetric conjugate?

Answer 8

distance between the sacral promontory and the midpoint of the symphysis pubis, and the shortest anteroposterior diameter of the pelvic inlet

Question 9

What factors are associated with breech presentation?

Answer 9

previous breech delivery
uterine anomalies
polyhydramnios
oligohydramnios
multiple gestations
PPROM
hydrocephaly 
anencephaly

Persistent breech presentation is also associated with placenta previa and fetal anomalies

Question 10

What are the complications of breech delivery for the fetus?

Answer 10

cord prolapse, entrapment of the fetal head, and fetal neurologic injury

Question 11

What are relative CIs to attempted vaginal delivery of a breech baby?

Answer 11

nulliparity
fetal weight greater than 3800 grams
incomplete breech presentation

Question 12

what is compound presentation

Answer 12

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

Question 13

A persistent OT position leading to arrest of labor is more common in women with a _____.

Answer 13

platypelloid pelvis

Question 14

What’s considered prolonged deceleration? bradycardia?

Answer 14

below 100 for 2 minutes

below 100 for 10 minutes

Question 15

how do you treat tetanic uterine contractions?

Answer 15

nitroglycerin or terbutaline

Question 16

What are the RFs for shoulder dystocia?

Answer 16

fetal macrosomia, preconceptional and gestational diabetes, previous shoulder dystocia, maternal obesity, postterm pregnancy, prolonged second stage of labor, and operative vaginal delivery.

Question 17

What fetal complications are associated with shoulder dystocia?

Answer 17

fractures of the humerus and clavicle, brachial plexus nerve injuries (Erb palsy), phrenic nerve palsy, hypoxic brain injury, and death.

Question 18

What maneuvers are used in shoulder dystocia?

Answer 18

• 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

Question 19

the risk of uterine rupture increases with

Answer 19

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

Question 20

How do you distinguish between a seizure and a vasovagal event?

Answer 20

post octal state