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Maternity > Labor & Birth Complications (Week 6) > Flashcards

Labor & Birth Complications (Week 6) Flashcards

1
Q

preterm labor

A

regular contractions
cervical changes
- effacement
- dilation (2cm)
- presentation

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2
Q

preterm birth timeframe

A

20 0/7 and 36 6/7

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3
Q

preterm labor vs Braxton hicks

A

Braxton hicks are no cervical changes

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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

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5
Q

can we induce with out valid reason

A

no

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6
Q

very preterm

A

<32

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7
Q

moderatley preterm

A

32-34

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8
Q

late preterm

A

34 0/7 - 36 6/7

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9
Q

preterm birth vs birth weight
- preterm

A

preterm is the length of gestation regardless of birth weight

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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

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11
Q

low birth weight grams

A

<2,500

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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

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13
Q

is preterm birth normally spontaneous or indicated

A

spontaneous

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14
Q

some causes of spontaneous labor and birth

A

multifactoral
infection
placental
maternal and fetal stress
uterine over distention

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15
Q

what is the only definitive factor for preterm labor

A

congenital

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16
Q

what are some examples of infection

A

colonization of upper and lower genital tract leading to UTI

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17
Q

what percent of preterm labor don’t have risk factors

A

50%

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18
Q

cervical length of what in the 2nd and 3rd trimester means unlikely to give birth

A

> 30mm

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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

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20
Q

age of viability

A

22-24

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21
Q

when do we need to have delivered after membranes ruptured

A

18 hours

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22
Q

does rupture of membranes mean labor

A

no

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23
Q

does preterm labor look like normal pregnancy symptoms

A

yes

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24
Q

what medication can help with preterm labor

A

progesterone

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25
Q

what do tocolytic medications do

A

stop contractions
arrest labor after contractions and cervical change has occurred

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26
Q

brethanone

A

off label of resp med for tocolytic

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27
Q

what med do we use for fetal lung maturity

A

betamethasone

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28
Q

betamethasone

A

12mg IM 2x apart

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29
Q

s/s of preterm labor

A

change in discharge - pink
dull back ache
pelvic abdominal pain
mild cramps
regular, frequent contractions
diarrhea

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30
Q

mag sulfate

A

decrease neural morbidity
not well understood
also get for preeclampsia

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31
Q

PROM

A

spontaneous rupture of aminitoci sac and leakage of fluid prior to the onset of labor at any gestational age

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32
Q

PPROM

A

membranes rupture before 37 0/7 weeks of gestation

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33
Q

what is PPROM often preceded by

A

infection
- choiro

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34
Q

for PROM what do we assess

A

color
time
odor

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35
Q

infection

A

non reassuring strip
steroids
antibiotics
mag

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36
Q

choiro

A

bacterial infection of the amniotic cavity

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37
Q

choiro s/s

A

maternal fever
maternal and fetal tachycardia
uterine tenderness
foul odor of amniotic fluid

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38
Q

how does choiro happen

A

vaginal flora bacteria ascend up the birth canal into amniotic fluids

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39
Q

risk of choiro

A

18 hr ruptured membrane
frequent vag exam
intruterine monitoring
young age
low SES
preexisting conditions
1st tiem pregnant

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40
Q

mom who is tachy
tender fundus
high WBC
purulent dischabge

A

choiro
- culture
possible steroids
antibiotics

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41
Q

choiro treatment

A

IV broad spectrum antibiotics and birth of fetus

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42
Q

choiro GBS

A

vaginal/rectal culture
35-37 weeks
only treated during labor
+GBS and no antibiotic increase risk of infant sepsis

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43
Q

how many doses do we want before birth

A

at least 2 doses q4
- preferably 4

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44
Q

postterm pregnancy date

A

> 42 weeks

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45
Q

what are we worried about with postterm

A

placenta starts to break down which disrupts O2 delivery during contraction leading to late decals

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46
Q

who is more likely to have oligo

A

post

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47
Q

who is more likley to have met stained fluids

A

post

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48
Q

what is the treatment for men stained fluid

A

treat same as no stained fluid

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49
Q

macrosomia

A

abnormal fetal growth

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50
Q

macrosomia leads to

A

shoulder dystocia

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51
Q

post maturity syndrome

A

dry cracker peeling skin with greenish tinged skin and cord with long nails

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52
Q

since the perinatal M&M increase greatly at 41 0/7 what do we do

A

kick count and seen in office 1-2 times a week

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53
Q

dystocia

A

lack go progress in labor for any reason

54
Q

what is the most common indicaiton of c/s

A

dystocia

55
Q

dystocia
- powers

A

ineffective contraction
ineffective bearing down

56
Q

dystocia
- passage

A

cervical edema

57
Q

dystocia
- passenger

A

position of the baby which influences the position of mom

58
Q

dystocia
- psychological

A

catecholmines

59
Q

precipitous labor

A

labor that lasts less than 3 hours from onset of cxn to time of birth

60
Q

what happens during precipitous labor

A

hard on mom
doesn’t allow stretching
baby bruised

61
Q

obese BMI

A

> 30

62
Q

who is external cephalic version most successful in

A

non obese
multip
with abundant amniotic fluids
fetus not engaged

63
Q

induction

A

chemical or mechanical intitation of uterine cxn before their spontaneous onset for the purpose of bringing about birth

64
Q

what is bishops score

A

cervcial ripeness

65
Q

what is a good score for bishops

A

8+ is good

66
Q

score of 0 for bisphops

A

closed
0-30%
-3
firm

67
Q

what station do you need for amniotomy

A

need station less than -3 cause you have to be ruptured

68
Q

goal of oxytocin

A

produce contractions of normal intensity duration and frequency using lowest dose

69
Q

what is a risk with oxytocin

A

tachysystole

70
Q

if the initial outbreak of herpes during 3rd trimester

A

baby is likely to get it

71
Q

augmentation

A

stimulation of uterine cxn after labor has started spontaneously and progress is unsatisfactory

72
Q

amniotomy

A

rupture of membranes

73
Q

common methods of augmentation

A

oxytocin and amnitomy

74
Q

shorten labor and less c section

A

presence of nurse to provide emotional and physical support

75
Q

forceps and vacuum are used in what phase of labor

A

2nd

76
Q

do forceps and vacuum work alone

A

no in conjunction of contraction and bearing down

77
Q

what do we need for for forceps and vacuum

A

fully dilated
ruptured
engaged
empty bladder
vertex

78
Q

for the vacuum since it is placed on the on the occiput what do we do

A

check fontanelle

79
Q

if the vacuum pops off how many times

A

3times

80
Q

vacuum risk

A

cephalohematoma

81
Q

which one crosses

A

caput

82
Q

VBAC

A

vaginal birth after cesarean

83
Q

TOLAC

A

trial of labor after cesarean

84
Q

cesaran complicaton

A

difficulty with intubation
drug reaction
aspiration pneumonia

85
Q

cesaran risks

A

infection
blood loss
pneumonia
clots

86
Q

Mac stained amniotic fluid more common with

A

closer to term

87
Q

what does mec stained fluid mean

A

fetus has passed stool prior to birth

88
Q

do we do tracheal suction for mec

A

no

89
Q

shoulder dystocia

A

head is born but anterior shoulder cannot pass under pubic arch

90
Q

who is at risk for shoulder dystocia baby

A

large baby

91
Q

who is at risk for shoulder dystocia mom

A

short mom
increase BMI

leading to atony and rupture

92
Q

shoulder dystocia injuries

A

asphyxia
brachial plexus damage
fracture

93
Q

shoulder dystocia
- turtle sign

A

when the head comes out and then back in

94
Q

shoulder dystocia
- once head is delivered

A

mark time

95
Q

shoulder dystocia
- mcroberts maneuver

A

bring legs up and out

96
Q

shoulder dystocia what do we do

A

mcroberts maneuver and suprapubic pressure

97
Q

shoulder dystocia do you do fundal pressure

A

no

98
Q

prolapsed cord

A

occurs when cord lies below presenting part of fetus

99
Q

how to treat prolapsed cord

A

push it back in
on hands and knees and put butt up

100
Q

rupture of uterus s/s

A

recurrent late and variables with pronged deceleration

sharp abd pain
bright red bag bleeding
crazy strip

101
Q

rupture of uterus risk

A

prev c/s or surgery

102
Q

what is best treatment for rupture

A

prevention

103
Q

amniotic fluid embolus

A

amniotic fluid containing particles of debris enter the maternal circulation and obstructs pulmonary vessels

104
Q

amniotic fluid embolus s/s

A

sudden acute onset of hypotension, hypoxia, hemorrhage caused by coagulopathy

105
Q

PPH blood loss amount

A

> 1000

106
Q

signs of early PPH

A

atony
- distended bladder
or cervical laceration

107
Q

saturation of pad in less than

A

15 min

108
Q

signs of late PPH

A

sub involution

109
Q

what is first priority for PPH

A

fundus

110
Q

what is the leading cause of PPH

A

atony

111
Q

placenta accreta

A

slight penetration of myometrium

112
Q

placental increta

A

deep penetration of myometrium

113
Q

placental percreta

A

perforation of mymetrum and uterine serosa. possible of involving adjacent organs

114
Q

bright red blood

A

arterial/deep

115
Q

dark red blood

A

venous/superfical

116
Q

hematoma

A

collection of blood in connective tissue
-pressure and can block bladder

117
Q

inversion of uterus

A

comes out backwards

118
Q

sub involution s/s

A

prolonged lochial discharge

119
Q

methergine

A

HTN

120
Q

hematite

A

asthma

121
Q

post PPH teaching

A

fatigue
increase iron
exhaustion
limit physical activity

122
Q

when bleeding in contious and there is no identifiable source

A

a coagulopathy can be the cause

123
Q

what coag state is preg

A

hypercoag

124
Q

puerperal infection

A

any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion or birth

125
Q

puerperal infection s/s

A

fever >100.4 for 2 or more days of the first 10 PP days

126
Q

endometritis

A

infection of the lining of the uterus

127
Q

endometritis tx

A

IV antibiotics

128
Q

most common PP infection

A

endometritis

129
Q

cystocele

A

bladder prolapse

130
Q

rectocele

A

retctum prolapse

131
Q

only lift as heavy as

A

the baby

132
Q
A

Maternity (15 decks)

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