Labor And Delivery Misc Flashcards
What factors negatively affect TOLAC success?
AMA Obesity PreE Short IPI ADvanced GA Macrosomia
Ideal TOLAC rate
60-70%
Risk of recurrent OASIS
3%
Diagnostic criteria for chorio
Temp 39c or 102.2f
Temp 38-38.9 on 2 occasions 30 min apart
PLUS
1. Fetal tachycardia 160 BPM for 10 minutes
2. Purulent cervical discharge
3. Wbc 15K
Treatment for chorio
Amp 2g IV q6
Gent 5mg/kg
Add flagyl or clinda if CD
After deliver, d/c abx if vag del
Continue x1 dose if CD
Vanc 15-20mg/kg q8h can be substituted for amp if PCN allergic
What are the risk factors for stillbirth?
Black race Nulliparity Diabetes Obesity Hypertension Substance abuse Multiple gestation ART
Work up for stillbirth
Family history (RPL, VTE) Maternal history OB history Fetal autopsy Placental examination Fetal Karyotype (amniotic fluid, 1x1cm placental segment, 1.5 cm cord segment) Labs: KB, APLAS, A1c, toxicology
Management of subsequent pregnancy after stillbirth
28 week growth US
Antenatal testing beginning at 32 weeks or two weeks prior to GA of previous stillbirth
Delivery timing for placenta accreta, percreta, increta
Vasa previa
34-35w
34-37w
Delivery timing for oligohydramnios
Polyhydramnios
36-37+6
39-40+6
Delivery timing for Di-Di twins with Isolated growth restriction
36-37+6
How is tachysystole defined
More than 5 contractions in 10 min averaged over 30 min
Definition of cat 3 FHT
Absent baseline variability AND
- Recurrent late
- Recurrent variable
- Bradycardia
Sinusoid all pattern
The following presentations require a cesarean section
Mentum posterior
Breech back down
Transverse back down (CLASSICAL)
Brow
Contraindications to a vacuum delivery
GA <34w Inability to assess fetal position Fetal bone mineralization disorders Fetal bleeding disorders Maternal ehler danlos
Mode of delivery for stillbirth, prior CD
13-24w D&E
24-28w miso600mcg q4h (okay even for VBAC)
After 28w, standard induction for VBAC
When to administer rx for GBS
\+GBS CX OR BACTERIuria Hx of neonate w GBS SEPSIS UNKNOWN GBS AND - <37w - ROM 18 hrs - GBS is prior pregnancy
What is the differential diagnosis of fetal tachycardia
Maternal infection Medication Medical disorders Abruption Fetal tacharrythmia (>200)
What is the differential diagnosis of minimal variability
Fetal sleep cycle (20-60min)
Magnesium sulfate
Opioids
Fetal acidemia
How do you define prolong latent phase?
Risks
> 20 hrs in nullip
14 in multip
THICK meconium,
five minute Apgar less than seven
NICU admission
How long should oxytocin be administered after AROM BEFORE declaring failed induction?
18 hrs
2nd tri pregnancy loss, medical induction regimen
400mcg miso q3 hrs for max 1400 in 24 hrs
Placenta should deliver in 4 hrs
