L&D Complications pt 2 Flashcards
Preterm labor
a common complication of pregnancy and is defined as delivery of a child between 20 and 37 weeks of gestation
RF preterm labor
prior cervical procedures
age < 17
age > 35
low socioeconomic status
poor access to care
interpersonal violence
poor nutrition
T2DM
asthma
HTN
kidney issues
thyroid issues
non physiologic anemia
MDD
vaginal/cervical infections
illicit drugs
smoking
multiple gestation etc
nhibition of acute preterm labor is often accomplished with
tocolytics such as indomethacin, nifedipine, or terbutaline. Magnesium sulfate can also be given, as well as corticosteroids for surfactant formation and antibiotics for group B Streptococcus infection
Tocolytics and delaying labor
Tocolytics are unlikely to delay labor for more than 48 hours once spontaneous induction of labor has begun
dx preterm labor
diagnosed based on the 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
specific measurements of cervical change that meet the criteria for preterm labor
at least one of the following: cervical dilation ≥ 3 cm, cervical length < 20 mm on transvaginal ultrasound, or cervical length between 20 and 30 mm with a positive fetal fibronectin
women w atypical sx of preterm labor, including pelvic pressure, cramping, or vaginal discharge, should be evaluated with what
fetal fibronectin test
why is fetal fibronectin test helpful when it is negative
this test is helpful when it is negative, as a negative test is associated with a 93–97% probability the patient will not deliver within 7–14 days
ppl w a negative test (less than 50 ng/mL) can typically be discharged home. Before being discharged home, the patient should be under observation for a period of 6–12 hours
management for preterm labor at ≥ 34 weeks gestation
women should be monitored for 4–6 hours to assess for progressive cervical dilation or effacement.
Women who progress should be admitted for delivery, and women without progression can be discharged if fetal well-being has been assured and there are no signs of obstetric complications, such as placental abruption, prelabor rupture of membranes, or intra-amniotic infection.
Women who are at ≥ 34 weeks gestation should not be given antenatal corticosteroids or tocolytic (anticontraction) agents.
management for preterm labor < 34 weeks
Women who are < 34 weeks of gestation presenting with preterm labor should be treated with tocolytic therapy for 48 hours, antibiotics for group B streptococcal prophylaxis, and antenatal corticosteroids for 48 hours
what are women given for neuroprotection (against cerebral palsy) if they present preterm labor between 24-32 weeks
magnesium sulfate
the tocolytic agent typically used for women with preterm labor who are between 24 and 32 weeks gestational age
indomethacin
the tocolytic agent typically used for women with preterm labor who are between 32 and 34 weeks gestational age
nifedipine
when are antenatal steroids recommended for preterm labor
between 22 weeks and 33 6/7 weeks gestational age
antenatal corticosteroids
betamethasone
dexamethasone
Why should indomethacin not be used for more than 48 hours in women who are in preterm labor?
Use for more than 48 hours can cause premature closure of the ductus arteriosus
is the fetal fibronectin test recommended in asx women
the fetal fibronectin test is not recommended in asymptomatic women since it has low sensitivity
what can be used to prevent preterm birth in women with shortened cervix
Progesterone and the cervical cerclage procedure
why are Antenatal corticosteroids and tocolytic therapy not used after 34 weeks gestation
because the neonatal morbidity and mortality are too low to outweigh the costs and potential maternal and fetal complications.
Electronic heart monitoring - when is it used
performed while women are in labor to determine the well-being and oxygenation status of the fetus
normal fetal HR
110-160
The causes of fetal bradycardia
fetal sleeping (unlikely during labor), umbilical cord prolapse, maternal hypotension, maternal hypoglycemia, anesthesia agents, and opioids
Late decelerations are associated with
uteroplacental insufficiency
Persistent late decelerations are an indication for
cesarean delivery
causes of fetal tachycardia
Fetal movement, maternal factors (anemia, hyperthyroidism, hypoxia, dehydration, fever or sepsis, and anxiety), fetal factors (dysrhythmias), and placental abruption
fetal accelerations before 32 weeks gestation
normal acceleration has a peak of ≥ 10 bpm above baseline for a duration of ≥ 10 seconds but < 2 minutes from onset to return
fetal accelerations after 32 weeks
normal accelerations are defined as an FHR peak of ≥ 15 bpm above baseline with a duration of ≥ 15 seconds but < 2 minutes from onset to return
reactive acceleration
two normal accelerations within a 20-minute period
anything less = nonreactive
prolonged acceleration
≥ 2 minutes but < 10 minutes
change in baseline FHR
acceleration ≥ 10 minutes
Early decelerations
benign and occur simultaneously with head compression during a uterine contraction
Variable decelerations
randomly occurring declarations with variable relations to contractions and are caused by mechanical compression of the umbilical cord
Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent, minimal, moderate, marked
what is absent
amplitude undetectable
Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent
what is minimal
amplitude range detectable but ≤ 5 bpm
Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent
what is moderate
which is normal, with an amplitude range between 6 and 25 bpm
Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent
what is marked
amplitude range > 25 bpm
Common indications for fetal surveillance
preexisting or gestational diabetes, hypertension, fetal growth restriction, twin pregnancy, postterm pregnancy, decreased fetal activity, oligohydramnios or polyhydramnios, prior fetal demise, and preterm prelabor rupture of membranes
A normal contraction stress test (oxytocin challenger test)
a normal baseline fetal heart rate (110–160 bpm) and the presence of at least three contractions lasting ≥ 40 seconds each within 10 minutes
A biophysical profile evaluates for
evaluates for a reactive nonstress test, one or more episodes of fetal breathing movements lasting ≥ 30 seconds, three or more discrete body or limb movements, one or more episodes of extremity extension with return to flexion or opening or closing of a hand, and maximum vertical amniotic fluid pocket > 2 cm. Each component is 2 points, and a score ≥ 8 points is considered normal
Compression of the fetal head leads to
early deceleration
during what stage of labor are early decelerations normally seen
second stage when the mother is actively using expulsive effort
early fetal deceleration
fetal heart rate monitor waveform consists of a gradual deceleration in the fetal heart that starts at the same time as the uterine contraction begins
sinusoidal pattern
A fetal heart rate baseline with a smooth, sine wave-like undulating pattern and a cycle frequency of 3–5 per minute lasting ≥ 20 minutes
Category 1 FHR monitoring
considered normal and must have a baseline fetal heart rate of 110–160 bpm, a moderate fetal heart rate variability, and no late or variable decelerations
Category 2 FHR monitoring
anything that does not fall into category I or III and warrants further investigation to determine prognosis
Category 3 FHR monitoring
considered abnormal and has at least one of the following: variability with recurrent late or variable decelerations, variability with recurrent bradycardia, or a sinusoidal pattern
