Chapters 32 & 33 - Labor And Birth / Postpartum Complications ( Lecture Review ) Flashcards
What defines preterm labor (PTL)?
Regular contractions with cervical effacement or dilation of at least 2 cm between 20 0/7 and 36 6/7 weeks.
What are the primary causes of spontaneous preterm birth?
Infection (definitive factor), uterine overdistention, placental abnormalities, fetal stress, congenital uterine anomalies, decrease in progesterone.
What interventions are used to prevent preterm birth?
Lifestyle modifications (activity restriction, no bedrest), tocolytic medications (to suppress contractions), antenatal glucocorticoids (promote fetal lung maturity).
What is the difference between PROM and PPROM?
PROM: Rupture of membranes before labor begins, regardless of gestation.
PPROM: Rupture before 37 weeks.
How is PPROM managed before 32 weeks?
Expectant management, infection monitoring, fetal assessment, glucocorticoids, antibiotics, magnesium sulfate (for neuroprotection).
What are signs of chorioamnionitis?
Maternal fever, maternal and fetal tachycardia, uterine tenderness, foul-smelling amniotic fluid.
When is a pregnancy considered postterm?
> 42 weeks
What are the maternal and fetal risks of postterm pregnancy?
Maternal: Dysfunctional labor, trauma, increased labor interventions.
Fetal: Macrosomia, shoulder dystocia, increased risk for operative birth.
What are the five factors affecting labor?
The powers, the passage, the passenger, maternal position, psychologic responses.
What is precipitous labor?
Labor lasting less than 3 hours from contraction onset to birth.
What fetal conditions can lead to dystocia?
Anomalies, cephalopelvic disproportion (CPD), malposition, malpresentation, multifetal pregnancy.
What BMI classifies a pregnant woman as obese?
BMI >30
What pregnancy complications are associated with obesity?
Spontaneous abortion, stillbirth, hypertensive disorders, gestational diabetes, congenital anomalies, C-section risk, venous thromboembolism.
At what gestational age is elective induction of labor recommended?
Not before 39 weeks.
What is the Bishop’s score used for?
To determine cervical ripeness before labor induction.
What methods are used for cervical ripening?
Chemical (prostaglandins, oxytocin) and mechanical (amniotomy).
What are VBAC and TOLAC?
VBAC: Vaginal birth after cesarean.
TOLAC: Trial of labor after cesarean.
What are the major risks of cesarean birth?
Infection, hemorrhage, thromboembolism, anesthesia complications, longer recovery.
What does meconium-stained amniotic fluid indicate?
Fetal distress, hypoxia, breech position, or normal maturity.
What is shoulder dystocia, and how is it managed?
The head is delivered, but the shoulder is stuck under the pubic bone.
McRoberts maneuver, suprapubic pressure, Gaskin maneuver.
What is a prolapsed umbilical cord, and what is the priority intervention?
The cord is below the presenting part of the fetus.
Reposition mother to relieve pressure on the cord.
What is an amniotic fluid embolism (AFE)?
A rare but fatal complication where amniotic fluid enters maternal circulation, causing hypotension, hypoxia, and hemorrhage.
What defines postpartum hemorrhage (PPH)?
> 1000 mL blood loss within 24 hours of birth with signs of hypovolemia.
What are the causes of early postpartum hemorrhage?
Tone: Uterine atony (most common).
Trauma: Vaginal, cervical, uterine lacerations.
Thrombin: Coagulopathy.
Tissue: Retained placenta.
