[CLMD] Obstetric Complications [Wootton] Flashcards
What are some nonmodifiable risk factors for Preterm Labor (PTL)?
Socioeconomic Factors – African Americans
Medical and Obstetrical Factors:
Previous HIstory of PTL
History of 2nd trimester abortion
Repeated Spont 1st trimester abortion
bleeding in 1st trimester
UTI
Twins
Uterine Abnormalities
Polyhydraminos
What are some modifiable risk factors of PTL?
Infection
Placental-Vascular
Pyschosocial Stress/Work Strain
Uterine Stretch
What associations are we considering with Infection/Cervical pathway in terms of modifiable risk factors of PTL?
Bacterial Vaginosis
Tx for Group B Strep
Tx for Gonorrhea/Chlamydia
In terms of cervical length how does it correlate with PTL?
As Cervical Length DECREASES; PTL INCREASES
Assess with Ultrasound, or Fetal Fibronectin (FFN)
What are the 3 components to the Placental-Vascular Pathway?
Immunological Component
Vascular Component
Low Resistance connection of Spiral A
(Alteration of either of these, results in poor fetal growth –> PTL)
What are the main hormones released in the Stress-Strain pathway that we can help to reduce?
Cortisol
Catecholamines
Uterine Stretch pathway is a result of increasing volume, and is a risk factor in what 2 things?
Polyhydraminos
Multiple Gestations
When & How do we diagnose PTL?
What symptoms are expected?
20-37 weeks w/ a CERVICAL EXAM, External Monitoring, FHR
Must have: Uterine Contractions, Cervical Dilation of 2cm (80% effacement)
Menstraul like cramping, Backache, Pelvic Pressure, Discharge (bloody), Uterine Contractions
Once you have done the initial assessment, and before you can confirm PTL, how do you manage the patient?
Reevaluate Cervix after an hour
Oral/IV Hydration
Bed Rest
Cultures Taken –> for Group B Strep
Ultrasound
Once you have DIAGNOSED PTL, how do you manage the patient?
Begin Tocolysis (MgSO4, Nifedipine, or Indomethacin)
also give Steroids if the baby is preterm (for Lung Growth)
What is the benefit of giving MgSO4?
Neuroprotection, (against Cerebral Palsy)
(MgSO4 is given if less than 32 weeks)
What are the benefits of giving Nifedipine for Tocolysis of a PTL patient?
Its an Oral agent
Minimal Maternal and Fetal Side affects
(replacing Mg as drug of choice)
What are the benefits/risks of giving Indomethacyin (Prostaglandin Synthetase Inhibitors)?
Inhibits Prostaglandin –> induce myometrial contractions
Can be given ORAL or RECTAL
Can result in Oligohydraminios
Can cause premature closure of Fetal DA –> Pul HTN –> HF
Necrotizing Enterocolitis, Intracranial Hemorrhage
What drug is not used for primary tx of preterm labor, but is shown to decrease uterine activity?
NSAIDS
When do you give Glucocorticoids (Betamethasone)?
For Fetal Lung Maturation
(given between 24-34 weeks) – lasts 7 days
What are the Risk Factors for PROM?
History of PROM
Vaginal/Cervical Infections
2nd/3rd trimester bleeding
Short Cervix
Low BMI
Low SES
smoking
Nutritional def
How do you diagnose PROM?
Loss of FLuid
Confirmation of Amniotic Fluid in Vagina
Check for Rupture using Sterile Speculum
(don’t check cervix of PPROM –> increases risk of infection)
How do you confirm PROM?
Pooling
Nitrazine Paper (turns blue)
Ferning
(US to evaluate amniotic fluid vol)
What is the Expectant management of PPROM?
Continue pregnancy until lung profile is mature (Check Gestational Age)
Deliver at 34 weeks
Antiobiotic course (Ampicillin, Erythromycin/Azithro)
Tocolytic
Steroids
Amniotic Fluid Index
Fetal/Maternal Status
In the case of PPROM, an intact amniotic sac prevents?
Chorioamnionitis
What is Intrauterine Growth Restriction (IUGR)?
When the birth weight of a newborn is below the 10% for a given gestational age
What are Growth Restricted fetuses at a higher risk for?
Meconium Aspiration
Hypoxia
Stillbirth
Polycethemia
Hypoglycemia
Cognitive Delay
Adult onset HTN. Diabetes, CAD, Stroke
How do we detect a fetus who is at risk of IUGR?
Physical Exam – Serial Fundal Heigth (primary screening tool)
US
Direct Studies – Amniocentesis, PUBS
Doppler Studies
What are placental causes of IUGR?
HTN
Renal Dz
Placental/Cord Abnorm
Preexsiting Diabetes
What are Fetal causes of IUGR?
Infections (TORCH, Listerosis)
Congenital Anomalies
Multiple Gestations
Chrom Abnorm
What are maternal causes of IUGR?
Bad Nutrtion
Smoking
Drug Abuse
Alcoholism
Cyanotic Heart Dz
Pulmonary Insuff
Antiphospholipid Synd
Hereditary Thrombophilias
Collagen Vascular Dz/Autoimmune Dz
Why do we use US for diagnosis of IUGR?
To get a weight of the baby
How do we manage IUGR, Pre-pregnancy?
Antepartum?
Controlling Diabetes, HTN
Deliver BEFORE fetal compromise
Decrease modifying factors
stop smoking
improve nutrtion
bed rest
MONITOR patient
What are some of techniques of Fetal Surveilance?
NonStress Testing (NST)
Biophysical Profile (BPP)
Doppler Study of Umbilical A
is IUGR an indication for C-Section?
NO!
What is the definition of a post-term pregnancy?
>42 weeks
(normal is 38-42 weeks)
If the baby is kept over 42 weeks, and isnt affected by palcental insufficiency what are they at a risk for?
Macrosomia (greater than 4500 grams)
Abnormal Labor
Shoulder Dystocia
C-Section
What causes a Post-Term Pregnancy?
Unsure Dates
Fetal Adrenal Hypoplasia
Anencephalic Fetuses
Placental Sulfatase Def
Extra-Uterine Preg
What would you do at the 41st week of a suspected Post-Term Preg?
42nd week?
Begin Antenatal testing: twice weekly NST and BPP
Induce labor if abnormal!!
————————————–
INDUCE LABOR!
What is Intrauterine Fetal Demise (IUFD)?
Causes?
Fetal Death after 20 weeks gestation, but before onset of labor
UNKNOWN – lots of associated causes
If a baby is kept post-term are they at a greater risk?
YES, they have a greater risk of Perinatal mortality,
and Postmaturity Syndrome (loss of subq fat, long fingernails, dry and peeling skin, abundant hair)
