Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > Complications of Labor > Flashcards

Complications of Labor Flashcards

1
Q

Definition of preterm labor?

A

Regular uterine contractions occurring at least q10min resulting in cervical change prior to 37 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the weight threshhold for Low Birth Weight (LBW)?

Very Low Birth Weight (VLBW)?

A

<2500g=LBW

<1500g=VLBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Between what two weeks gestation does survival rate increase by 5% each day?

A

Between 25-26 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

There is an association with preterm labor and what 3 genital tract colonizations?

A
  1. Group B Strep
  2. Neisseria gonorrhoeae
  3. Bacterial Vaginosis organisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What can be done to stop or attempt to slow contractions to avoid Preterm labor?

A

Tocolytic therapy (also an epidural can avoid pushing).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tocolytic therapy can be used up to how many weeks gestation?

A

34 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the ultimate goal of tocolytic therapy?

A

Short term use to permit corticosteroid treatment to aid fetal lung maturation and allow potential transfer to NICU prepared facility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 6 tocolytic therapies available?

A
  1. Ethanol
  2. Magnesium
  3. Calcium-Channel Blockers
  4. Beta-Adrenergic Agonists
  5. Prostaglandin Synthetase Inhibitors
  6. Methylxanthines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does methylxanthines (aminophylline) produce tocolysis?

A

Phosphodiesterase inhibitor which increases cAMP, causes uterine muscle relaxation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is an example of a Calcium Channel Blocker used in tocolytic therapy?

A

Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are maternal side effects of Nifedipine use?

A
  1. Hypotension, tachy, dizzy, palpitations, flushing
  2. Myocardial depression
  3. Hepatic dysfunction
  4. Postpartum hemorrhage
  5. Decrease UBF=fetal hypoxemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why do calcium channel blockers increase risk of post-partum hemorrhage?

A

Uterine atony refractory to oxytocin and prostaglandin F-a2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are two examples of Prostaglandin Synthetase Inhibitors?

A
  1. Indomethacin

2. Sulindac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MOA of indomethacin and sulindac?

A

Decrease cyclooxygenase which decreaes prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are maternal side effects of indomethacin and sulindac?

A
  1. Nausea
  2. Heartburn
  3. Transient dec. bleeding aggregation (bleeding)
  4. Primary Pulm HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are fetal side effects of indomethacin and sulindac?

A
  1. Crosses placenta
  2. Premature closure of ductus arteriosus
  3. Persistent fetal circulation
  4. Renal impairment- oliguria.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does magnesium produce tocolysis?

A

Competes with Ca++ to decrease contractility by activating adenylcyclase and increasing cAMP

18
Q

If magnesium therapy is performed for tocolysis, how would your anesthetic plan change?

A

Use decreased doses of DNMBA and NDNMBA.

MAC decreases

19
Q

What is normal serum mag treatment range?

A

4 to 7mg/100ml

20
Q

At what serum mag levels are toxicity signs seen?

A

8-10 loss of deep tendon reflexes.
10-15 Resp depression and Wide QRS/PR interval.
20+= cardiac arrest

21
Q

What is treatment for magnesium toxicity?

A

Calcium Gluconate or CaCL

22
Q

What are examples of Beta Adrenergic Agonists used for tocolytic therapy?

A

Terbutaline and ritodrine

23
Q

How do terbutaline and ritodrine cause tocolysis?

A

Increase cAMP causes uterine relaxations

24
Q

What are side of effects of terbutaline and ritodrine?

A
  1. N/V
  2. Anxiety/restlessness
  3. Hyperglycemia, hypokalemia, acidosis
  4. Tachy, arrhythmias, dec PVR, dilutional anemia,
  5. Pulmonary edema
25
Q

Risk factors involved in beta adrenergic agonist therapy and pulmonary edema?

A
  1. Undiagnosed CHF/LV dysfunction
  2. Infection
  3. Hypokalemia
  4. Tocolysis >24hrs
  5. Multiple gestations
  6. Concomitant mag therapy
26
Q

How much does fetal mortality risk change in twins vs singleton pregnancy?

A

5-6x increase in twins (because of increase in risk of prematurity)

27
Q

What are 5 maternal consequences of multiple gestation pregnancies?

A
  1. CV- Increased CO earlier on.
  2. Heme- Increased incidence of anemia
  3. Resp- Dec TLC, dec FRC, inc closing capacity
  4. Metabolic- Inc oxygen consumption, inc metabolic rate
  5. Reproductive- Larger uterus=aortocaval compression, greater aspiration risk.
28
Q

Preterm labor occurs in approx how many multiple gestation pregnancies?

A

40-50%

29
Q

What LA is preferred for twin births and why?

A

2 Chloroprocaine 3% because of rapid onset.

30
Q

What medication can be given to provide uterine relaxation for internal manipulation of fetus(es)?

A

Nitroglycerine 100mcg (max 500).

31
Q

What are 5 signs of uterine rupture?

A
  1. Sudden abd pain
  2. Vaginal bleeding
  3. Hypotension
  4. Cessation of labor
  5. Fetal distress
32
Q

What is the most reliable sign of uterine rupture?

A

Fetal distress

33
Q

What are 9 risk factors of uterine rupture?

A
  1. Previous uterine surgery
  2. Trauma
  3. Multiparity
  4. Uterine anomaly
  5. Oxytocin
  6. Placenta percreta
  7. Tumors
  8. Macrosomia
  9. Malposition
34
Q

What abnormal presentation is an absolute indication for c-section?

A

Transverse lie

35
Q

What presentation has greatest chance of uncomplicated spontaneous vaginal delivery?

A

Vertex presentation with flexed c spine and anterior occiput.

36
Q

What are the three variations of breech?

A
  1. Complete breech (both feet first)
  2. Incomplete breech ( 1 foot first, 1 foot up)
  3. Frank Breech (butt first).
37
Q

What are the complications associated with post-maturity gestation (beyond 42 weeks)?

A

Dec uteroplacental blood flow.
Umbilical compression.
Meconium staining of amniotic fluid.
Macrosomia and shoulder dystocia

38
Q

How long of a window of time before fetal compromise with a prolapsed umbilical cord?

A

10 minutes

39
Q

What anesthetic management would you take with intrauterine fetal demise?

A

Epidural, IV analgesia, remember to ruleout coagulopathy as cause of demise

40
Q

What is most common cause of intrauterine fetal demise?

A

Cord accidents (prolapse, cord length, entanglement, torsion)

41
Q

What does the acronym VEAL CHOP Mean?

A

(V) Variable Decels= (C) Cord Compression
(E) Early Decels= (H) Head Compression
(A) Accelerations= (O) OK or Oxygen
(L) Late Decels= (P) Placental Insufficiency

Obstetrics (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions