Labor & Birth Complications (Week 6) Flashcards
1
Q
preterm labor
A
regular contractions
cervical changes
- effacement
- dilation (2cm)
- presentation
2
Q
preterm birth timeframe
A
20 0/7 and 36 6/7
3
Q
preterm labor vs Braxton hicks
A
Braxton hicks are no cervical changes
4
Q
why do we have decreased rates of preterm birth
A
improved fertility practices
quality improvement
increased use of strategies to prevent recurrent preterm birth
5
Q
can we induce with out valid reason
A
no
6
Q
very preterm
A
<32
7
Q
moderatley preterm
A
32-34
8
Q
late preterm
A
34 0/7 - 36 6/7
9
Q
preterm birth vs birth weight
- preterm
A
preterm is the length of gestation regardless of birth weight
10
Q
what is more dangerous birth weight or preterm
A
preterm since there is less time in the uterus that correlates with immaturity of body systems
11
Q
low birth weight grams
A
<2,500
12
Q
what is an example of intrauterine growth restriction
A
hypertension which leads to constrictions and decreased perfusion to cord which decreases nutrients to grow
13
Q
is preterm birth normally spontaneous or indicated
A
spontaneous
14
Q
some causes of spontaneous labor and birth
A
multifactoral
infection
placental
maternal and fetal stress
uterine over distention
15
Q
what is the only definitive factor for preterm labor
A
congenital
16
Q
what are some examples of infection
A
colonization of upper and lower genital tract leading to UTI
17
Q
what percent of preterm labor don’t have risk factors
A
50%
18
Q
cervical length of what in the 2nd and 3rd trimester means unlikely to give birth
A
> 30mm
19
Q
what is the fetal fibronectin test
A
this is the glue found in plasma and produced during fetal life
want a negative
- negatove test means you are not likely to go into labor within next 2 weeks
20
Q
age of viability
A
22-24
21
Q
when do we need to have delivered after membranes ruptured
A
18 hours
22
Q
does rupture of membranes mean labor
A
no
23
Q
does preterm labor look like normal pregnancy symptoms
A
yes
24
Q
what medication can help with preterm labor
A
progesterone
25
what do tocolytic medications do
stop contractions
arrest labor after contractions and cervical change has occurred
26
brethanone
off label of resp med for tocolytic
27
what med do we use for fetal lung maturity
betamethasone
28
betamethasone
12mg IM 2x apart
29
s/s of preterm labor
change in discharge - pink
dull back ache
pelvic abdominal pain
mild cramps
regular, frequent contractions
diarrhea
30
mag sulfate
decrease neural morbidity
not well understood
also get for preeclampsia
31
PROM
spontaneous rupture of aminitoci sac and leakage of fluid prior to the onset of labor at any gestational age
32
PPROM
membranes rupture before 37 0/7 weeks of gestation
33
what is PPROM often preceded by
infection
- choiro
34
for PROM what do we assess
color
time
odor
35
infection
non reassuring strip
steroids
antibiotics
mag
36
choiro
bacterial infection of the amniotic cavity
37
choiro s/s
maternal fever
maternal and fetal tachycardia
uterine tenderness
foul odor of amniotic fluid
38
how does choiro happen
vaginal flora bacteria ascend up the birth canal into amniotic fluids
39
risk of choiro
18 hr ruptured membrane
frequent vag exam
intruterine monitoring
young age
low SES
preexisting conditions
1st tiem pregnant
40
mom who is tachy
tender fundus
high WBC
purulent dischabge
choiro
- culture
possible steroids
antibiotics
41
choiro treatment
IV broad spectrum antibiotics and birth of fetus
42
choiro GBS
vaginal/rectal culture
35-37 weeks
only treated during labor
+GBS and no antibiotic increase risk of infant sepsis
43
how many doses do we want before birth
at least 2 doses q4
- preferably 4
44
postterm pregnancy date
>42 weeks
45
what are we worried about with postterm
placenta starts to break down which disrupts O2 delivery during contraction leading to late decals
46
who is more likely to have oligo
post
47
who is more likley to have met stained fluids
post
48
what is the treatment for men stained fluid
treat same as no stained fluid
49
macrosomia
abnormal fetal growth
50
macrosomia leads to
shoulder dystocia
51
post maturity syndrome
dry cracker peeling skin with greenish tinged skin and cord with long nails
52
since the perinatal M&M increase greatly at 41 0/7 what do we do
kick count and seen in office 1-2 times a week
53
dystocia
lack go progress in labor for any reason
54
what is the most common indicaiton of c/s
dystocia
55
dystocia
- powers
ineffective contraction
ineffective bearing down
56
dystocia
- passage
cervical edema
57
dystocia
- passenger
position of the baby which influences the position of mom
58
dystocia
- psychological
catecholmines
59
precipitous labor
labor that lasts less than 3 hours from onset of cxn to time of birth
60
what happens during precipitous labor
hard on mom
doesn't allow stretching
baby bruised
61
obese BMI
>30
62
who is external cephalic version most successful in
non obese
multip
with abundant amniotic fluids
fetus not engaged
63
induction
chemical or mechanical intitation of uterine cxn before their spontaneous onset for the purpose of bringing about birth
64
what is bishops score
cervcial ripeness
65
what is a good score for bishops
8+ is good
66
score of 0 for bisphops
closed
0-30%
-3
firm
67
what station do you need for amniotomy
need station less than -3 cause you have to be ruptured
68
goal of oxytocin
produce contractions of normal intensity duration and frequency using lowest dose
69
what is a risk with oxytocin
tachysystole
70
if the initial outbreak of herpes during 3rd trimester
baby is likely to get it
71
augmentation
stimulation of uterine cxn after labor has started spontaneously and progress is unsatisfactory
72
amniotomy
rupture of membranes
73
common methods of augmentation
oxytocin and amnitomy
74
shorten labor and less c section
presence of nurse to provide emotional and physical support
75
forceps and vacuum are used in what phase of labor
2nd
76
do forceps and vacuum work alone
no in conjunction of contraction and bearing down
77
what do we need for for forceps and vacuum
fully dilated
ruptured
engaged
empty bladder
vertex
78
for the vacuum since it is placed on the on the occiput what do we do
check fontanelle
79
if the vacuum pops off how many times
3times
80
vacuum risk
cephalohematoma
81
which one crosses
caput
82
VBAC
vaginal birth after cesarean
83
TOLAC
trial of labor after cesarean
84
cesaran complicaton
difficulty with intubation
drug reaction
aspiration pneumonia
85
cesaran risks
infection
blood loss
pneumonia
clots
86
Mac stained amniotic fluid more common with
closer to term
87
what does mec stained fluid mean
fetus has passed stool prior to birth
88
do we do tracheal suction for mec
no
89
shoulder dystocia
head is born but anterior shoulder cannot pass under pubic arch
90
who is at risk for shoulder dystocia baby
large baby
91
who is at risk for shoulder dystocia mom
short mom
increase BMI
leading to atony and rupture
92
shoulder dystocia injuries
asphyxia
brachial plexus damage
fracture
93
shoulder dystocia
- turtle sign
when the head comes out and then back in
94
shoulder dystocia
- once head is delivered
mark time
95
shoulder dystocia
- mcroberts maneuver
bring legs up and out
96
shoulder dystocia what do we do
mcroberts maneuver and suprapubic pressure
97
shoulder dystocia do you do fundal pressure
no
98
prolapsed cord
occurs when cord lies below presenting part of fetus
99
how to treat prolapsed cord
push it back in
on hands and knees and put butt up
100
rupture of uterus s/s
recurrent late and variables with pronged deceleration
sharp abd pain
bright red bag bleeding
crazy strip
101
rupture of uterus risk
prev c/s or surgery
102
what is best treatment for rupture
prevention
103
amniotic fluid embolus
amniotic fluid containing particles of debris enter the maternal circulation and obstructs pulmonary vessels
104
amniotic fluid embolus s/s
sudden acute onset of hypotension, hypoxia, hemorrhage caused by coagulopathy
105
PPH blood loss amount
>1000
106
signs of early PPH
atony
- distended bladder
or cervical laceration
107
saturation of pad in less than
15 min
108
signs of late PPH
sub involution
109
what is first priority for PPH
fundus
110
what is the leading cause of PPH
atony
111
placenta accreta
slight penetration of myometrium
112
placental increta
deep penetration of myometrium
113
placental percreta
perforation of mymetrum and uterine serosa. possible of involving adjacent organs
114
bright red blood
arterial/deep
115
dark red blood
venous/superfical
116
hematoma
collection of blood in connective tissue
-pressure and can block bladder
117
inversion of uterus
comes out backwards
118
sub involution s/s
prolonged lochial discharge
119
methergine
HTN
120
hematite
asthma
121
post PPH teaching
fatigue
increase iron
exhaustion
limit physical activity
122
when bleeding in contious and there is no identifiable source
a coagulopathy can be the cause
123
what coag state is preg
hypercoag
124
puerperal infection
any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion or birth
125
puerperal infection s/s
fever >100.4 for 2 or more days of the first 10 PP days
126
endometritis
infection of the lining of the uterus
127
endometritis tx
IV antibiotics
128
most common PP infection
endometritis
129
cystocele
bladder prolapse
130
rectocele
retctum prolapse
131
only lift as heavy as
the baby
132
