L&D

Question 1

Define preterm labor

Answer 1

presence of regular and painful uterine contractions that are approximately 5 minutes apart for an hour and accompanied by cervical change (dilation or effacement) prior to 37 weeks of gestational age

Cervical changes:
* cervical dilation >/= 3cm
* cervical length < 20mm
* OR cervical lenght bet 20-30mm AND + fetal fibronectin

Question 2

In the setting of preterm labor, what is the goal of tx with tocolytic agents and abx

Answer 2

delay labor for 48 hours - allows time for corticosteroids to improve fetal lung development

Question 3

preferred tocolytic for women between 24-32 weeks

Answer 3

Indomethacin

Question 4

tocolytic for women between 32-34 weeks

Answer 4

Nifedipine

Question 5

What are some commonly used tocolytic drugs?

Answer 5

Magnesium sulfate, indomethacin, terbutaline, and nifedipine

Question 6

FHR pattern mneumonic

Answer 6

VEAL - CHOPS
* V - variable decelerations = C - cord compresion
* E - early decelerations = H - head compression
* A - accelerations = O - ok
* L - late decelerations = P - placental insufficiency

Question 7

what is considered reactive FHR accelerations?

Answer 7

FHR peak > 15 bpm above baseline for > 15 sec, 2 times in 20 minutes

Question 8

what are the risk factors of umbilical cord prolapse

Answer 8

• malpresentation of the fetus - frank breech
• prematurity
• low birth weight
• uterine malformation
• multiparity
• long umbilical cord
• prolonged labor

Question 9

clinical presumptive diagnostic criteria for intraamniotic infection (chorioamnionitis)

Answer 9

fever >/= 102.2 without another clear source
OR
fever 100.4-102.0 without another clear source AND one of the following
* maternal leukocytosis WBCs >15,000
* fetal tachycardia >160
* purulent or malodorous amniotic fluid

Question 10

Treatment of intraamniotic infection

Answer 10

prompt augmentation or induction of labor and abx
- ampicillin and gentamicin

Question 11

maternal complications of IAI

Answer 11

postpartum endometritis
uterine atony
pph

Question 12

what is the MOST common identifiable risk factor for PPROM

Answer 12

A gentical tract infection (ex. Gardnerella vaginalis)

Question 13

what are risk factors for preterm labor?

Answer 13

• prior cervical procedures
• age < 17 or > 35y/o
• Low SES/edu
• poor nutrition, low preg BMI
• med: T1DM, htn, thyroid disorder, asthma,
• some infections
• alco, cocaine, heroin, and tobacco
• short cervical length
• hx of preterm delivery
• short pregnancy interval