Class 2 Complications of Labor Flashcards
What is “Term”?
Single pregnancy 37-42 completed weeks
Preterm labor definition.
Regular contractions at least every 10 minutes resulting in cervical change prior to 37 weeks.
Low birth weight (LBW)
infant < 2500g
Very low birth weight (VLBW)
Infant < 1500g
Infant mortality for < 24 weeks, < 30 weeks, >34 weeks?
- 90% death
- 90% survival
- 98% survival
Survival can increase ___% each day between weeks __ - ___.
- 5%
- 25 - 26
8 Premature comorbidities.
- intercranial hemorrhage
- Ischemic cerebral damage
- Immature metabolism
- Hypoglycemia
- Hyperbilirubin
- Necrotizing enterocolitis
- respiratory distress
- Sepsis
When is premature respiratory distress seen? And what exacerbates the symptoms?
- All infants < 27 weeks 0% by 36 weeks
- Intrapartum hypoxia and maternal stress
What 3 bacteria causes preterm labor?
- Group B Strep
- Gonorrhea
- Bacterial vaginosis
When is C-section safer than vaginal delivery for PTL?
Breech
How does an epidural help in PTL?
- Avoids precipitous delivery
- Decrease risk of ICH
- Avoids maternal pushing against incomplete cervix
What are tocolytics?
- Drugs used to stop or slow contractions
- Used between 20-34 weeks and <2500 g
Are tocolytics used for long term or short term use and why?
- Short term
- Allow time for steroids to aid in lung maturation or transfer to a NICU
How doe ethanol work as a tocolytic?
- Inhibits release of ADH and Oxytocin
- Direct effect on myometrium
- Interference with prostaglandins
3 risks of ethanol?
- Intoxication
- LOC
- Aspiration
How does methylxanthines work as tocolytics and what is the side effect?
- Phosphodiesterases increase cAMP and cause uterine muscle relaxation
- Narrow therapeutic margin
How do calcium channel blockers work as tocolytic?
-Decrease free calcium = decreased contractility
Name a calcium channel blocker tocolytic.
-Nifedipine
2 major problems with calcium channel blockers?
- More prone to cardiac depressant effect of volatile agents
- Increased risk of post partum hemorrhage due to uterine atony
2 examples of prostaglandin synthetase inhibitors used as tocolytics. and how does it work?
- indomethacin and Sulindac
- Decrease cyclooxygenase = decreased prostaglandins
Maternal side effects of Prostaglandin Synthetase Inhibitors.
- nausea
- Heartburn
- Platelet aggregation
- Pulm HTN
Fetal side effects of Prostaglandin Synthetase Inhibitors.
- Crosses placenta
- closure of ductusarterosis
- Fetal circulation
- renal impairment
What is the most common tocolytic used and how does it work?
- Magnesium
- Competes with calcium for uterine smooth muscle binding which decreases contractility
A patient on Mag is more sensitive to what type of drugs?
-Both depolarizing and non-depolarizing muscle relaxants
A patient on MAG has a ________ MAC for inhalational agents.
-Decreased
What is the normal treatment range for MAG?
-4-7mg
What happens at MAG levels of 8-10? 10-15? 20+
- Loss of DTR
- Resp depression, Wide QRS, ↑ P-R
- Cardiac arrest
Beta adrenergic agonist tocolytic therapy meds.
- Terbutaline
- Ritodrine
Major problem with Beta adrenergic agonists.
-Beta agonist pulmonary edema
Beta agonist pulmonary edema risk factors.
- IV fluids
- Multiple gestation
- Tocolysis > 24hrs
- MAG therapy
- Infection
- Hypokalemia
- Heart disease
Why is mortality of 2nd twin increased?
- Placental abruption
- Cord prolapse
- Malpresentation
Maternal consequences of multiple gestation.
- Increased CO
- Anemia
- ↓ TLC, FRC
- increased Closing capacity
- Increased O2 Consumption
- Increased metabolic rate
- Increased aspiration risk
What may be required for internal manipulation, and what drug is used?
- Uterine relaxation
- Nitroglycerine
Signs of uterine rupture.
- Abdominal pain
- Vag bleeding
- Hypotension
- Cessasition of labor
- Fetal distress (most reliable)
Presentation with Greatest chance of uncomplicated birth?
- Vertex
- Flexed C-spine
- Occiput anterior
What is External cephalic version?
-Manipulation of fetus through the abdominal wall.
What is post maturity?
-Gestation beyond 42 weeks
Complications of post-maturity
- Decreased uterine blood flow
- Cord compression
- Meconium staining of amniotic fluid
- Macrosomia
Most common cause of intrauterine fetal demise.
-Cord accidents
If there is prolonged retention of fetus ______ may become a concern.
DIC
Describe prolapsed umbilical cord.
- Cord presents through cervix and is compressed by baby
- 10 minutes before fetal demise
What is Monoamniotic twins? and what is the associated risk?
- Share single placenta and amniotic sack
- Cord entanglement
Risk of cords 72cm
- Compression, constriction and rupture
- Entanglement
What is a nuchal cord?
Cord around neck
What is umbilical cord torsion?
twisting of cord around itself
