Complications of L&D Flashcards
leading cause of fetal m&m in US?
preterm delivery
what is considered low birthweight?
< 2500g
prematurity => increased risks of what?
Resp'y distress syndrome hyaline mem dis intraventricular hemorrhage sepsis NEC
RFs for PTL:
PROM chorioamnionitis placental abruption maternal low bw previous PTL low SES multiple gestation uterine anomalies maternal preeclampsia, infection, dis
what is the only FDA-approved tocolytic?
ritodrine
most tocolytics prolong gestation by how much? Why does this help?
48h. Helps allow betamethasone tx for fetal lung maturity.
ritodrine and terbutaline are what kind of drug? How do they work?
beta-agonists (bind to and activate B2 R’s => increased cAMP => sequestration of Ca2+ in SR, inh of MLCK)
SEs of ritodrine & terbutaline?
HA
tachycardia
anxiety
rare pulmonary edema & death
how does magnesium sulfate work?
is a calcium blocker & membrane stabilizer
SEs of magnesium:
flushing
HA
fatigue
diplopia
what is a toxic mag level? Signs of toxicity?
10mg/dL resp'y depression pulm edema hypoxia cardiac arrest loss of DTRs
what’s the best way to r/o mag tox?
serial reflex checks
SE’s of nifedipine:
HA
flushing
dizziness
how should tocolytics be dosed?
Loading dose then maintenance doses.
how does indomethacin work?
blocks COX => decreases PG level
indomethacin is ass’d w/what in fetus?
premature closure of ductus arteriosus
pulm HTN
oligohydramnios 2/2 renal failure
what % of pg’ies end with PTD?
10%
how long will it usually take for labor to start in a pt w/premature ROM?
24-48h without intervention
what is the tampon test?
inject a dye into amniotic sac. Watch for it to come out vagina onto tampon. If it does, ROM has occurred.
when is the risk of prematurity = to the risk of infection in a pt w/PPROM?
b/w 32 and 36 weeks.
what med is indicated in PPROM and why?
ampicillin +/- erythromycin, b/c it prolongs the onset of labor
how long are tocolytics usually admin’d after PPROM?
48h to admin a course of corticosteroids
what is FTP?
failure to progress in labor
what are the 4 shapes of maternal pelvis?
gynecoid
android
anthropoid
platypelloid
what is the obstetric conjugate?
distance b/w sacral promontory and symphysis pubis (shortest AP diam of pelvic inlet)
what to do in a case of suspected cephalopelvic disproportion?
usually a trial of labor, unless u/s or CT have shown CPD
incidence of breech presentation?
3-4%
what are the 3 types of breech presentation?
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
what are the 3 mgt options for breech babies?
external version
trial of vaginal delivery
c/s
what are CI’s to trial of vaginal delivery w/breech baby?
nulliparity
incomplete breech
fetal weight > 3800g
when can a vaginal delivery occur with face presentation?
with mentum anterior presentation (chin up)
why is a brow presentation considered a malpresentation?
b/c a larger diameter m/pass thru pelvis this way.
what is a compound presentation?
an extremity presenting alongside the vertex or breech
how to manage a compound presentation?
if its an upper extremity, try gently reducing it.
If its a leg, need c/s.
what do you need to suspect in all cases of compound presentation?
umb cord prolapse
what is a persistent occiput transverse position? Why tends to get this?
baby’s head remains turned to one side, doesn’t do internal rotation towards Occiput Anterior.
Moms w/a platypelloid pelvis.
mgt of persistent OT?
manual rotation
forceps or vacuum
how to classify the etiologies of prolonged FHR decels?
pre-uterine
utero-placental
postplacental
what are some pre-uterine causes of prolonged FHR decels?
maternal PE, amniotic fluid embolus, MI, seizure, hypotension 2/2 epidural
what are some utero-placental causes of prolonged FHR decels?
abruption
infarction
previa
uterine hyperstiml’n
what are some post-placental causes of prolonged FHR decels?
cord prolapse
cord compression
rupture of fetal bv
approach to finding the cause of FHR decels:
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)
mgt of FHR decels:
turn mom onto her other side
give mom O2
what to do if maternal hypotension 2/2 epidural?
IV fluids, ephedrine
tx of tetanic uterine ctr’ns:
NTG
terbutaline
mgt of umb cord prolapse:
c/s, lifting fetal head off cord.
what is shoulder dystocia?
impaction of ant shoulder behind pubic symphysis
RF’s for shoulder dystocia:
fetal macrosomia pre-gestational & gestational DM previous shoulder dystocia maternal ob postterm pg'y long 2nd stage operative vag delivery
if you anticipate a shoulder dystocia, how to prepare?
pt in dorsal lithotomy position
cut episiotomy
tx of shoulder dystocia:
- McRoberts maneuver
- suprapubic P
- rubin maneuver
- wood corkscrew maneuver
- Deliver post arm/shoulder
what is McRoberts maneuver
sharp flexion of maternal hips to decrease inclination of pelvis
what is Rubin maneuver:
get your hand on one accessible shoulder and push it towards baby’s chest. Decreases overall bisacromial diameter.
what is wood corkscrew maneuver?
apply P behind post shoulder to rotate infant & dislodge ant shoulder
what to do if maneuvers don’t work to dislodge ant shoulder?
try them again. If still doesn’t work, break clavicle.
what is zavanelli maneuver?
put infant’s head back into pelvis, take to c/s.
how to diff’ate b/w seizure and vasovagal events?
seizure has a post-ictal state. Vasovagal events may be accompanied by tonic-clonic jerks, but no post-ictal state.
mgt of pg pt w/seizures:
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.
