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OB/GYN > Complications of L&D > Flashcards

Complications of L&D Flashcards

1
Q

leading cause of fetal m&m in US?

A

preterm delivery

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2
Q

what is considered low birthweight?

A

< 2500g

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3
Q

prematurity => increased risks of what?

A 
Resp'y distress syndrome
hyaline mem dis
intraventricular hemorrhage
sepsis
NEC
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4
Q

RFs for PTL:

A 
PROM
chorioamnionitis
placental abruption
maternal low bw
previous PTL
low SES
multiple gestation
uterine anomalies
maternal preeclampsia, infection, dis
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5
Q

what is the only FDA-approved tocolytic?

A

ritodrine

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6
Q

most tocolytics prolong gestation by how much? Why does this help?

A

48h. Helps allow betamethasone tx for fetal lung maturity.

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7
Q

ritodrine and terbutaline are what kind of drug? How do they work?

A

beta-agonists (bind to and activate B2 R’s => increased cAMP => sequestration of Ca2+ in SR, inh of MLCK)

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8
Q

SEs of ritodrine & terbutaline?

A

HA
tachycardia
anxiety
rare pulmonary edema & death

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9
Q

how does magnesium sulfate work?

A

is a calcium blocker & membrane stabilizer

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10
Q

SEs of magnesium:

A

flushing
HA
fatigue
diplopia

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11
Q

what is a toxic mag level? Signs of toxicity?

A 
10mg/dL
resp'y depression
pulm edema
hypoxia
cardiac arrest
loss of DTRs
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12
Q

what’s the best way to r/o mag tox?

A

serial reflex checks

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13
Q

SE’s of nifedipine:

A

HA
flushing
dizziness

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14
Q

how should tocolytics be dosed?

A

Loading dose then maintenance doses.

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15
Q

how does indomethacin work?

A

blocks COX => decreases PG level

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16
Q

indomethacin is ass’d w/what in fetus?

A

premature closure of ductus arteriosus
pulm HTN
oligohydramnios 2/2 renal failure

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17
Q

what % of pg’ies end with PTD?

A

10%

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18
Q

how long will it usually take for labor to start in a pt w/premature ROM?

A

24-48h without intervention

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19
Q

what is the tampon test?

A

inject a dye into amniotic sac. Watch for it to come out vagina onto tampon. If it does, ROM has occurred.

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20
Q

when is the risk of prematurity = to the risk of infection in a pt w/PPROM?

A

b/w 32 and 36 weeks.

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21
Q

what med is indicated in PPROM and why?

A

ampicillin +/- erythromycin, b/c it prolongs the onset of labor

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22
Q

how long are tocolytics usually admin’d after PPROM?

A

48h to admin a course of corticosteroids

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23
Q

what is FTP?

A

failure to progress in labor

24
Q

what are the 4 shapes of maternal pelvis?

A

gynecoid
android
anthropoid
platypelloid

25
Q

what is the obstetric conjugate?

A

distance b/w sacral promontory and symphysis pubis (shortest AP diam of pelvic inlet)

26
Q

what to do in a case of suspected cephalopelvic disproportion?

A

usually a trial of labor, unless u/s or CT have shown CPD

27
Q

incidence of breech presentation?

A

3-4%

28
Q

what are the 3 types of breech presentation?

A

complete - feet are near fetal head
frank - knees are flexed, feet are near the breech, not at the head.
incomplete/footling - foot is in vagina

29
Q

what are the 3 mgt options for breech babies?

A

external version
trial of vaginal delivery
c/s

30
Q

what are CI’s to trial of vaginal delivery w/breech baby?

A

nulliparity
incomplete breech
fetal weight > 3800g

31
Q

when can a vaginal delivery occur with face presentation?

A

with mentum anterior presentation (chin up)

32
Q

why is a brow presentation considered a malpresentation?

A

b/c a larger diameter m/pass thru pelvis this way.

33
Q

what is a compound presentation?

A

an extremity presenting alongside the vertex or breech

34
Q

how to manage a compound presentation?

A

if its an upper extremity, try gently reducing it.

If its a leg, need c/s.

35
Q

what do you need to suspect in all cases of compound presentation?

A

umb cord prolapse

36
Q

what is a persistent occiput transverse position? Why tends to get this?

A

baby’s head remains turned to one side, doesn’t do internal rotation towards Occiput Anterior.
Moms w/a platypelloid pelvis.

37
Q

mgt of persistent OT?

A

manual rotation

forceps or vacuum

38
Q

how to classify the etiologies of prolonged FHR decels?

A

pre-uterine
utero-placental
postplacental

39
Q

what are some pre-uterine causes of prolonged FHR decels?

A

maternal PE, amniotic fluid embolus, MI, seizure, hypotension 2/2 epidural

40
Q

what are some utero-placental causes of prolonged FHR decels?

A

abruption
infarction
previa
uterine hyperstiml’n

41
Q

what are some post-placental causes of prolonged FHR decels?

A

cord prolapse
cord compression
rupture of fetal bv

42
Q

approach to finding the cause of FHR decels:

A

1) eval mom for signs of resp’y compromis or AMS
2. while putting on a glove for cervical exam, look at mom’s HR and BP
3. look for increased vaginal bleeding
4. Perform a cervical exam. Abdominal hand should feel for uterine tetany, fetal parts outside uterus, fetal station higher than expected (suspects uterine rupture)

43
Q

mgt of FHR decels:

A

turn mom onto her other side

give mom O2

44
Q

what to do if maternal hypotension 2/2 epidural?

A

IV fluids, ephedrine

45
Q

tx of tetanic uterine ctr’ns:

A

NTG

terbutaline

46
Q

mgt of umb cord prolapse:

A

c/s, lifting fetal head off cord.

47
Q

what is shoulder dystocia?

A

impaction of ant shoulder behind pubic symphysis

48
Q

RF’s for shoulder dystocia:

A 
fetal macrosomia
pre-gestational & gestational DM
previous shoulder dystocia
maternal ob
postterm pg'y
long 2nd stage
operative vag delivery
49
Q

if you anticipate a shoulder dystocia, how to prepare?

A

pt in dorsal lithotomy position

cut episiotomy

50
Q

tx of shoulder dystocia:

A
  1. McRoberts maneuver
  2. suprapubic P
  3. rubin maneuver
  4. wood corkscrew maneuver
  5. Deliver post arm/shoulder
51
Q

what is McRoberts maneuver

A

sharp flexion of maternal hips to decrease inclination of pelvis

52
Q

what is Rubin maneuver:

A

get your hand on one accessible shoulder and push it towards baby’s chest. Decreases overall bisacromial diameter.

53
Q

what is wood corkscrew maneuver?

A

apply P behind post shoulder to rotate infant & dislodge ant shoulder

54
Q

what to do if maneuvers don’t work to dislodge ant shoulder?

A

try them again. If still doesn’t work, break clavicle.

55
Q

what is zavanelli maneuver?

A

put infant’s head back into pelvis, take to c/s.

56
Q

how to diff’ate b/w seizure and vasovagal events?

A

seizure has a post-ictal state. Vasovagal events may be accompanied by tonic-clonic jerks, but no post-ictal state.

57
Q

mgt of pg pt w/seizures:

A

1) ABCs
2) check FHR
3) give a bolus of MgSO4
4) lorazepam
5) phenytoin
6) if still seizing, try phenobarbital
7) get labs - electrolytes, AED levels, G, tox screen
8) if FHR continues t/b nonreassuring, emergent delivery.

OB/GYN (29 decks)

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