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OB Exam 2 > Labor & Birth Complications -- Week 4 > Flashcards

Labor & Birth Complications -- Week 4 Flashcards

1
Q

Preterm Labor (PTL)

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A

Regular contractions with a change in cervical effacement or dilation or both or presentation with regular uterine contractions & cervical dilation of at least 2 cm

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2
Q

Preterm Birth

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A

A birth that occurs between weeks 20 & 36 6/7 weeks of gestation; more dangerous than low birth weight

  • Very Preterm: < 32 weeks
  • Moderately Preterm: 32 - 34 weeks
  • Late Preterm: 34 - 36 6/7 weeks

75% of all births in the US are preterm

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3
Q

What is considered preterm birth?

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A

Birth between 20 weeks & 36 6/7 weeks

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4
Q

Define Very Preterm, Moderately Preterm, & Late Preterm Births

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A
  • Very Preterm: < 32 weeks
  • Moderately Preterm: 32-34 weeks
  • Late Preterm: 34 - 36 6/7 weeks
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5
Q

What percentage of all births in the US are preterm?

A

75%

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6
Q

Low Birth Weight

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A

< 2500 grams (5.5 lbs); intrauterine growth restriction (IUGR)

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7
Q

What is Intrauterine Growth Restriction (IUGR)?

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A

limited nutrients from the placenta to the baby

  • can result in low birth weight – < 2500 grams (5.5 lbs)
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8
Q

Spontaneous Preterm Birth

A

Spontaneous preterm births occur following an early initiation of the labor process absent of fetal or maternal illness

  • 75% of preterm births

Causes: pathogens, infection, abnormalities, allergic reaction

Risk Factors: socioeconomic status

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9
Q

Indicated Preterm Birth

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A

Occurs as a means to resolve maternal or fetal risk that is often related to the continuation of the current pregnancy

  • diabetes, HTN, preeclampsia, etc.
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10
Q

Fetal Fibronectin Test (fFN)

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A

used to predict who will NOT go into preterm labor (< 1%)

  • glycoprotein “glue” found in plasma & produces during fetal life
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11
Q

Signs of Preterm Labor

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A
  • Vaginal discharge change / increase
  • Pelvic pressure
  • Mild abdominal cramps
  • Constant dull back pain
  • Regular contractions / ruptured membrane
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12
Q

What medications are used for fetal lung maturity?

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A

antenatal glucocorticoids (ACT)

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13
Q

Premature Rupture of Membranes (PROM)

A

Spontaneous rupture of the amniotic sac & loss of amniotic fluid before labor begins

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14
Q

Preterm Premature Rupture of Membranes (PPROM)

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A

Ruptured membranes in preterm pregnancy (before 37 weeks)

  • preceeded by infection (chorioamniotitis)
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15
Q

Chorioamnionitis

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A

Bacterial infection of the amniotic cavity (major complication for mothers)

S/S: fever, tachycardia, uterine tenderness, foul odor amniotic fluid

Tx: IV antibiotics & birth of the fetus / GBS (group beta strep) test

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16
Q

S/S of Chorioamnionitis

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A
  • Fever
  • Tachycardia
  • Uterine tenderness
  • Foul odor amniotic fluid
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17
Q

Postterm Pregnancy

A

birth at > 42 weeks (0.5% of mothers)

  • increases maternal morbidity, dysfunctional labor, abnormal growth, shoulder dystocia, meconium stained fluid
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18
Q

Dystocia (dysfunctional labor)

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A

Difficult labor for any reason

abnormal contractions; hypertonic uterine dysfunction; latent / active; protraction (slower); arrest (cease); anesthesia; precipitous labor (< 3 hours); intrauterine pressure catheter (IUPC); tachysystole; pelvic structure; cervical edema; fetal causes (anomalies, CPD, malposition, multifetal); psychological (anxiety)

the 5 Ps = challenges

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19
Q

Obesity

A

**At an increased risk for certain complications: **spontaneous abortions, stillbirth, HTN, gestational diabetes, C/S, VTE

Difficulties in Care: difficult fetal monitoring, routine procedures taking more time, mobility issues, wound infections

20
Q

External Cephalic Version (ECV)

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A

External rotation of the fetus into the proper delivery position (usually performed by 2 doctors)

Contraindications: anomalies, 3rd trimester bleeding, placental insufficiency

21
Q

Induction of Labor

A
  • chemical or mechanical
  • initiation of uterine contractions before they’re spontaneous
  • onset to bring about birth
  • > 39 weeks, increased risk for C-section

Station is not -3 or higher
* must be free of HSV

22
Q

Amniotomy

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A

Artificial rupture of membranes

23
Q

Bishops Score

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A

A rating system used to evaluate inducibility or cervical ripeness

  • Determines likeliness of havign a vaginal delivery
24
Q

Augmentation of Labor

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A

Stimulation of ineffective uterine contractions after labor has started spontaneously but is not progressing satisfactorily

Ex:
* IV pitocin
* oxytocin
* amniotomy

25
Q

Active Management of Labor

A

Aggressive use of oxytocin so that the woman gives birth within 12 hours of admission to the labor unit

26
Q

Operative Vaginal Birth

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A

Vacuum or forceps used during vaginal birth
* maternal exhaustion

Must be: fully dilated, empty bladder, vertex position, ruptured membrane, fetal head circumference

  • After birth, check for hematoma, lacerations, & bruises
27
Q

VBAC

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A

Vaginal Birth After Cesarean Section

28
Q

TOLAC

KNOW THIS!!!!!

A

Trial of Labor After Cesarean Section

Allowing labor to progress naturally for women who want to have a VBAC

29
Q

Elective Cesarean Section

A

Maternal request

30
Q

Risks associated with Cesarean Section

A
  • Intubation complications
  • aspiration
  • pneumonia
  • hemorrhage
  • bowel / bladder injury
  • amniotic fluid embolism
  • VTE
  • wound infection
  • UTI
31
Q

Meconium Stained Fluid

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A

Fetus has passed stool prior to birth

  • Obstetric Emergency!!!!!!
  • Could indicate breech, hypoxia peristalsis, cord compression
32
Q

Shoulder Dystocia

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A

Head is born, but anterior shoulder cannot pass under pubic arch

  • Injuries related to asphyxia, brachial damage, & facture
  • maternal blood loss, episiotomy, PP hemorrhage

Tx:
* McRoberts maneuver & suprapubic pressure
* Gaskin maneuver

33
Q

Prolapsed Umbilical Cord

KNOW THIS!!!!!

A

When the umbilical cord presents first & is squeezed between the vaginal wall & the baby’s head

  • can insert fingers to relieve pressure off the cord, knees to chest position
34
Q

Uterine Rupture

KNOW THIS!!!!!

A

Tear in the wall of the uterus

  • prevention is the best tx
35
Q

Amniotic Fluid Embolism (AFE)

KNOW THIS!!!!!

A

Anaphylactoid syndrome

Sudden, acute onset of hypotension, hypoxia, & hemorrhage

  • Cause: coagulopathy
  • Mortality Rate: 20 - 60%
  • Amniotic fluid can contain vernix, hair, cells, skin, meconium

Risk Factors: maternal age, post-term, induction, eclampsia, c/s, forceps / vacuum

36
Q

Postpartum Hemorrhage

KNOW THIS!!!!!

A

Cumulative blood loss > 1,000 mL or s/s of hypovolemia within 24 hours post birth

Causes
* Early (within 24 hourso f birth): atony or bladder distension
* late (> 24 hours but less than 6 weeks of birth): infection, subinvolution, coagulation

37
Q

Causes of early postpartum hemorrhage

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A

within 24 hours of birth

  • atony
  • bladder distension
38
Q

Causes of late postpartum hemorrhage

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A

> 24 hours but less than 6 weeks after birth

  • infection
  • subinvolution
  • coagulation
39
Q

Uterine Atony

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A

uterus doesn’t return to firm, pre-birth state (uterus is boggy, weak, etc.)

  • most common cause of PP hemorrhage
  • RF: more pregnancies, large fetus, obesity, multifetal gestation
40
Q

Placental Complications

A
  • retained placenta
  • fragments of placenta
  • placenta accreta: slight penetration of myometrium
  • placenta increta: deep penetration of myometrium
  • placenta percreta: perforation of myometrium & uterine serosa
  • hematomas
  • lacerations
  • inversion of the uterus
  • subinvolution of the uterus
41
Q

Placenta accreta

A

slight penetration fo myometrium (middle layer of the uterine wall)

42
Q

Placenta increta

A

deep penetration of myometrium (middle layer of the uterine wall)

43
Q

Placenta percreta

A

perforation of myometrium (middle layer of uterine wall) and uterine serosa (tissue coating the outside of the uterus)

44
Q

Postpartum Management

KNOW THIS!!!!!

A

MASSAGE THE FUNDUS (void before)

  • increase oxytocin / hemabate / methergine (caution w/ HTN & asthma)
  • Surgical management
45
Q

VTE

A

venous thromboembolism

  • DVT / PE
  • pain & tenderness in the lower extremity, edema, warmth
46
Q

Postpartum Infection

A

Infection of the genital tract that occurs within 28 days after miscarraige, abortion, or birth

S/S: fever > 100.4 for 2+ days during first 10 days PP

  • Endometritis: infection of lining of uterus
  • most common PP infection
  • TX = IV abx
  • Wound infections:
  • develop after being discharged
  • 3 - 5% in c-sections
  • UTIs: occur in 2 - 4% of PP women
47
Q

Pelvic floor disorders

A

Cystocele, rectocele, uterine prolapse

  • avoid lifting / straining
  • kegels

OB Exam 2 (3 decks)

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