Complications of labor and delivery Flashcards
- Preterm labor is considered how many weeks?
2. Regular uterine contractions associated with what?
- Prior to 37 weeks
2. cervical change
Risk Factors for Preterm Labor
9
- Multiple gestation*
- Prior preterm birth*
- Preterm uterine contractions
- Premature rupture of membranes
- Low maternal prepregnancy weight
- Smoking
- Substance abuse
- Short interpregnancy interval
- Infection (UTI, genital tract, periodontal disease)
PP of Preterm labor? 4
- Activation of the maternal or fetal hypothalamic-pitutary-adrenal axis due to maternal or fetal stress
- Deciual-choioamniotic or systemic inflammation caused by infection:
- Decidual hemorrhage:
Abruption* - Pathologic uterine distension:
Pathologic uterine distension can be caused by what?
3
- Multiple pregnancy
- Polyhydramnios
- Uterine abnormality
Signs & Symptoms of Preterm Labor
7
- Menstrual like cramps
- Low, dull backache
- Abdominal pressure
- Pelvic pressure
- Abdominal cramping with or without diarrhea
- Increase or change in vaginal discharge (mucous, water, light bloody discharge)
- Uterine contractions (may be painless)
Evaluation of preterm labor?6
- Fetal monitoring
- UA,
- test for Group B strep,
- CBC
- Ultrasound:
- Amniocentesis:
What would the ultrasound show?
2
- Evaluate amount of amniotic fluid
2. Estimate cervical length if
Amniocentesis:
Can determine what? 2
- Can determine intramniotic infection
2. May be used to determine fetal lung maturity
Management
- Primary goal?
- Detection and treatment of the disorder associated with what?
- Therapy for preterm labor?
- Primary goal is to delay delivery until fetal maturity is attained
- Detection and treatment of the disorder associated with preterm labor
- Therapy for preterm labor
- Tocolytics are what?
2. What are they? 4
- Medication to stop preterm labor:
- Calcium channel blockers (nifedipine)
- NSAIDS (indocin)
- B-adrenergic receptor agonists (terbutaline)
- Magnesium sulfate
Contraindications to Tocolyics
10
- Advanced labor
- Mature fetus
- Severely abnormal fetus or fetal demise
- Intrauterine infection
- Significant vaginal bleeding
- Severe preeclampsia or eclampsia
- Placental abruption
- Advanced cervical dilation
- Fetal compromise
- Placental insufficiency
Corticosteroids
- Why might you give corticosteroids?
- Maximal benefitif given when?
- What weeks?
- Dosing over what period of time?
- What does it reduce? 3
- Corticosteroids given to the mother to enhance fetal lung maturity
- Maximal benefit if given within 7 days of delivery
- From 24-34 weeks gestation
- Dosing over 48 hours
- Reduces:
- Fetal respiratory distress
- Intraventricular hemorrhage
- Necrotizing enterocolitis
Stre[tpcpccis agalactiae
(Group B streptococcus)
1. Genital tract colonization of ______% pregnant women
- Universal screening for GBS between _____ weeks gestation**
- If positive administer what?
- When else would we administer this?
- 15-40
- 35-36
- antibiotic prophylaxis in labor or with premature rupture of membranes
- OR if pregnant mother has had prior infant with GBS infection*
GBS Antibiotic Prophylaxis
- Drug?
- Best if given when?
- Penicillin G 5 million U IV followed by 2,5-3 million U q 4 hrs. until delivery
- Best if given 4 hrs. prior to delivery
GBS Antibiotic Prophylaxis
If PCN allergy give what? 3
If PCN allergy then:
- Cefazolin (If no h/o anaphylaxis to PCN)
- Or Clindamycin
- Or Vancomycin
GBS Colonization
- Treatment prevents what?
- Prevents what in the mother?
- May have asymptomatic what?
- Treatment prevents Group B sepsis of the neonate
- (In the mother) Prevents postpartum endometritis, sepsis and in rare cases meningitis
- May have asymptomatic bacturia during pregnancy and that should be treated*
What is the Leading indication for c-section?
Dystocia
- Dystocia. What is it?
2. AKA?
- Dystocia—abnormal progression of labor- Defined as lack of progressive cervical dilation of lack of descent of fetal head in birth canal or both
- Also referred to as “failure to progress”
Evaluation of Labor
5
- Is the uterus contracting accurately? (internal monitor)
- What is the fetal position?
- Is there indication of cephalopelvic disproportion?
- What is the fetal status? FHR tracing- want to see accerlations and variability
- Is there concern for chorioaminonitis?
Progression of Labor
- Cervix should dilate how much for nulliparous?
- Multiparous?
- Fetus should descend at least ____ per hour.
- Should not be longer than __ hrs. if regional anesthesia
- Should not be longer that __ hrs. if no anesthesia
- Second stage arrest is what?
Cervix should dilate:
- 1 cm/hr in nulliparous
- 1.5 cm/hr in multiparous
- Fetus should descend at least 1 cm/hr.
- 3
- 2
- no descent after 1 hr. of pushing