L&D Complications pt 2

Question 1

Preterm labor

Answer 1

a common complication of pregnancy and is defined as delivery of a child between 20 and 37 weeks of gestation

Question 2

RF preterm labor

Answer 2

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

Question 3

nhibition of acute preterm labor is often accomplished with

Answer 3

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

Question 4

Tocolytics and delaying labor

Answer 4

Tocolytics are unlikely to delay labor for more than 48 hours once spontaneous induction of labor has begun

Question 5

dx preterm labor

Answer 5

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

Question 6

specific measurements of cervical change that meet the criteria for preterm labor

Answer 6

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

Question 7

women w atypical sx of preterm labor, including pelvic pressure, cramping, or vaginal discharge, should be evaluated with what

Answer 7

fetal fibronectin test

Question 8

why is fetal fibronectin test helpful when it is negative

Answer 8

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

Question 9

management for preterm labor at ≥ 34 weeks gestation

Answer 9

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.

Question 10

management for preterm labor < 34 weeks

Answer 10

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

Question 11

what are women given for neuroprotection (against cerebral palsy) if they present preterm labor between 24-32 weeks

Answer 11

magnesium sulfate

Question 12

the tocolytic agent typically used for women with preterm labor who are between 24 and 32 weeks gestational age

Answer 12

indomethacin

Question 13

the tocolytic agent typically used for women with preterm labor who are between 32 and 34 weeks gestational age

Answer 13

nifedipine

Question 14

when are antenatal steroids recommended for preterm labor

Answer 14

between 22 weeks and 33 6/7 weeks gestational age

Question 15

antenatal corticosteroids

Answer 15

betamethasone
dexamethasone

Question 16

Why should indomethacin not be used for more than 48 hours in women who are in preterm labor?

Answer 16

Use for more than 48 hours can cause premature closure of the ductus arteriosus

Question 17

is the fetal fibronectin test recommended in asx women

Answer 17

the fetal fibronectin test is not recommended in asymptomatic women since it has low sensitivity

Question 18

what can be used to prevent preterm birth in women with shortened cervix

Answer 18

Progesterone and the cervical cerclage procedure

Question 19

why are Antenatal corticosteroids and tocolytic therapy not used after 34 weeks gestation

Answer 19

because the neonatal morbidity and mortality are too low to outweigh the costs and potential maternal and fetal complications.

Question 20

Electronic heart monitoring - when is it used

Answer 20

performed while women are in labor to determine the well-being and oxygenation status of the fetus

Question 21

normal fetal HR

Answer 21

110-160

Question 22

The causes of fetal bradycardia

Answer 22

fetal sleeping (unlikely during labor), umbilical cord prolapse, maternal hypotension, maternal hypoglycemia, anesthesia agents, and opioids

Question 23

Late decelerations are associated with

Answer 23

uteroplacental insufficiency

Question 24

Persistent late decelerations are an indication for

Answer 24

cesarean delivery

Question 25

causes of fetal tachycardia

Answer 25

Fetal movement, maternal factors (anemia, hyperthyroidism, hypoxia, dehydration, fever or sepsis, and anxiety), fetal factors (dysrhythmias), and placental abruption

Question 26

fetal accelerations before 32 weeks gestation

Answer 26

normal acceleration has a peak of ≥ 10 bpm above baseline for a duration of ≥ 10 seconds but < 2 minutes from onset to return

Question 27

fetal accelerations after 32 weeks

Answer 27

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

Question 28

reactive acceleration

Answer 28

two normal accelerations within a 20-minute period

anything less = nonreactive

Question 29

prolonged acceleration

Answer 29

≥ 2 minutes but < 10 minutes

Question 30

change in baseline FHR

Answer 30

acceleration ≥ 10 minutes

Question 31

Early decelerations

Answer 31

benign and occur simultaneously with head compression during a uterine contraction

Question 32

Variable decelerations

Answer 32

randomly occurring declarations with variable relations to contractions and are caused by mechanical compression of the umbilical cord

Question 33

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

Answer 33

amplitude undetectable

Question 34

Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent

what is minimal

Answer 34

amplitude range detectable but ≤ 5 bpm

Question 35

Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent

what is moderate

Answer 35

which is normal, with an amplitude range between 6 and 25 bpm

Question 36

Fluctuations in the baseline FHR are caused by any changes in amplitude and frequency and can range from absent

what is marked

Answer 36

amplitude range > 25 bpm

Question 37

Common indications for fetal surveillance

Answer 37

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

Question 38

A normal contraction stress test (oxytocin challenger test)

Answer 38

a normal baseline fetal heart rate (110–160 bpm) and the presence of at least three contractions lasting ≥ 40 seconds each within 10 minutes

Question 39

A biophysical profile evaluates for

Answer 39

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

Question 40

Compression of the fetal head leads to

Answer 40

early deceleration

Question 41

during what stage of labor are early decelerations normally seen

Answer 41

second stage when the mother is actively using expulsive effort

Question 42

early fetal deceleration

Answer 42

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

Question 43

sinusoidal pattern

Answer 43

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

Question 44

Category 1 FHR monitoring

Answer 44

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

Question 45

Category 2 FHR monitoring

Answer 45

anything that does not fall into category I or III and warrants further investigation to determine prognosis

Question 46

Category 3 FHR monitoring

Answer 46

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