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Personal OB > Class 2 Complications of Labor > Flashcards

Class 2 Complications of Labor Flashcards

1
Q

What is “Term”?

A

Single pregnancy 37-42 completed weeks

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2
Q

Preterm labor definition.

A

Regular contractions at least every 10 minutes resulting in cervical change prior to 37 weeks.

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3
Q

Low birth weight (LBW)

A

infant < 2500g

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4
Q

Very low birth weight (VLBW)

A

Infant < 1500g

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5
Q

Infant mortality for < 24 weeks, < 30 weeks, >34 weeks?

A
  • 90% death
  • 90% survival
  • 98% survival
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6
Q

Survival can increase ___% each day between weeks __ - ___.

A
  • 5%

- 25 - 26

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7
Q

8 Premature comorbidities.

A
  • intercranial hemorrhage
  • Ischemic cerebral damage
  • Immature metabolism
  • Hypoglycemia
  • Hyperbilirubin
  • Necrotizing enterocolitis
  • respiratory distress
  • Sepsis
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8
Q

When is premature respiratory distress seen? And what exacerbates the symptoms?

A
  • All infants < 27 weeks 0% by 36 weeks

- Intrapartum hypoxia and maternal stress

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9
Q

What 3 bacteria causes preterm labor?

A
  • Group B Strep
  • Gonorrhea
  • Bacterial vaginosis
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10
Q

When is C-section safer than vaginal delivery for PTL?

A

Breech

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11
Q

How does an epidural help in PTL?

A
  • Avoids precipitous delivery
  • Decrease risk of ICH
  • Avoids maternal pushing against incomplete cervix
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12
Q

What are tocolytics?

A
  • Drugs used to stop or slow contractions

- Used between 20-34 weeks and <2500 g

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13
Q

Are tocolytics used for long term or short term use and why?

A
  • Short term

- Allow time for steroids to aid in lung maturation or transfer to a NICU

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14
Q

How doe ethanol work as a tocolytic?

A
  • Inhibits release of ADH and Oxytocin
  • Direct effect on myometrium
  • Interference with prostaglandins
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15
Q

3 risks of ethanol?

A
  • Intoxication
  • LOC
  • Aspiration
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16
Q

How does methylxanthines work as tocolytics and what is the side effect?

A
  • Phosphodiesterases increase cAMP and cause uterine muscle relaxation
  • Narrow therapeutic margin
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17
Q

How do calcium channel blockers work as tocolytic?

A

-Decrease free calcium = decreased contractility

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18
Q

Name a calcium channel blocker tocolytic.

A

-Nifedipine

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19
Q

2 major problems with calcium channel blockers?

A
  • More prone to cardiac depressant effect of volatile agents

- Increased risk of post partum hemorrhage due to uterine atony

20
Q

2 examples of prostaglandin synthetase inhibitors used as tocolytics. and how does it work?

A
  • indomethacin and Sulindac

- Decrease cyclooxygenase = decreased prostaglandins

21
Q

Maternal side effects of Prostaglandin Synthetase Inhibitors.

A
  • nausea
  • Heartburn
  • Platelet aggregation
  • Pulm HTN
22
Q

Fetal side effects of Prostaglandin Synthetase Inhibitors.

A
  • Crosses placenta
  • closure of ductusarterosis
  • Fetal circulation
  • renal impairment
23
Q

What is the most common tocolytic used and how does it work?

A
  • Magnesium

- Competes with calcium for uterine smooth muscle binding which decreases contractility

24
Q

A patient on Mag is more sensitive to what type of drugs?

A

-Both depolarizing and non-depolarizing muscle relaxants

25
Q

A patient on MAG has a ________ MAC for inhalational agents.

A

-Decreased

26
Q

What is the normal treatment range for MAG?

A

-4-7mg

27
Q

What happens at MAG levels of 8-10? 10-15? 20+

A
  • Loss of DTR
  • Resp depression, Wide QRS, ↑ P-R
  • Cardiac arrest
28
Q

Beta adrenergic agonist tocolytic therapy meds.

A
  • Terbutaline

- Ritodrine

29
Q

Major problem with Beta adrenergic agonists.

A

-Beta agonist pulmonary edema

30
Q

Beta agonist pulmonary edema risk factors.

A
  • IV fluids
  • Multiple gestation
  • Tocolysis > 24hrs
  • MAG therapy
  • Infection
  • Hypokalemia
  • Heart disease
31
Q

Why is mortality of 2nd twin increased?

A
  • Placental abruption
  • Cord prolapse
  • Malpresentation
32
Q

Maternal consequences of multiple gestation.

A
  • Increased CO
  • Anemia
  • ↓ TLC, FRC
  • increased Closing capacity
  • Increased O2 Consumption
  • Increased metabolic rate
  • Increased aspiration risk
33
Q

What may be required for internal manipulation, and what drug is used?

A
  • Uterine relaxation

- Nitroglycerine

34
Q

Signs of uterine rupture.

A
  • Abdominal pain
  • Vag bleeding
  • Hypotension
  • Cessasition of labor
  • Fetal distress (most reliable)
35
Q

Presentation with Greatest chance of uncomplicated birth?

A
  • Vertex
  • Flexed C-spine
  • Occiput anterior
36
Q

What is External cephalic version?

A

-Manipulation of fetus through the abdominal wall.

37
Q

What is post maturity?

A

-Gestation beyond 42 weeks

38
Q

Complications of post-maturity

A
  • Decreased uterine blood flow
  • Cord compression
  • Meconium staining of amniotic fluid
  • Macrosomia
39
Q

Most common cause of intrauterine fetal demise.

A

-Cord accidents

40
Q

If there is prolonged retention of fetus ______ may become a concern.

A

DIC

41
Q

Describe prolapsed umbilical cord.

A
  • Cord presents through cervix and is compressed by baby

- 10 minutes before fetal demise

42
Q

What is Monoamniotic twins? and what is the associated risk?

A
  • Share single placenta and amniotic sack

- Cord entanglement

43
Q

Risk of cords 72cm

A
  • Compression, constriction and rupture

- Entanglement

44
Q

What is a nuchal cord?

A

Cord around neck

45
Q

What is umbilical cord torsion?

A

twisting of cord around itself

Personal OB (7 decks)

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