Complications of labor Wolfe Flashcards
LBW vs VLBW
VLBL <1500g
LBW <2500g
What are some comorbidites with prematurity?
RDS
Sepsis
NEC
ICH
Hypoglycemia
Hyperbilirubinemia
Ischemic Cerebral damage
Immature metabolism
Preterm labor can be associated with ___
Genital tract colonization
Group B sterp
Neisseria gonorrhea
BV
Can be prevented with ABX
PTL anesthetic considerations
C/s or vaginal- c/s safer with breech
With epidural- avoid fast delivery, avoid pushing against an incomplete cervix
When are tocolytics useful
Prevent labor
20-34 weeks to bridge to steroids which hasten lung maturity
<2500g in the ABSENCE of fetal distress only
Tocolytic exmaples
CCB (nifedipine) lower intrauterine ca
Beta agonists (terbutaline, ritodrine) relax uterus
PG inhibitors- indomethacin, sulindac
Mag lowers Ca but will sensitize to NMBs
Methylxanthines via PDE
Ethanol (no longer used)
The tocolytic, mag, will do what to MAC?
Decrease
S/e of beta agonists tocolytics
Pulmonary edema
N.v
Anxiety, restless
Hyperglycemia
Tachy
Fetal mortality is increased ___ in twins
5-6x
Likely d/t risk of prematurity
Which twin is safer
First
Think abruption, cord prolapse, malpresentation
What LA for epidural of multigestationals?
2-chlorprocaine 3% for raid onset
How can u relax the uterus for internal manipulation?
NTG 100mcg, max 500mcg
S&S uterine rupture
Fetak distress- most reliable sign
Sudden vaginal pain despite functioning epidural
Vaginal bleeding
HOTN
Cessation of labor
Most breech are delivered by
C/s- especially for transverse lie
Breech increases risk of
Fetal death
Asphyxia
Trauma
Maternal infection d/t internal infection
