Labor & Delivery Flashcards
Maternal contraindications to use of prostaglandins
asthma, glaucoma
Obstetric contraindications to use of prostaglandins
multiple prior C/S, nonreassuring fetal testing
Montevideo unit
average of the variation of the intrauterine pressure from baseline x # of contractions in a 10-minute period
Common indications for primary C/S
- labor dystocia
- nonreassuring FHR
- fetal malpresentation
- multiple gestation
- suspected fetal macrosomia
active phase arrest
absence of cervical change for 2+ hours in the presence of adequate uterine contractions and cervical dilation of 4+cm
Signs of uterine rupture
- abdominal pain
- FHR decelerations or bradycardia
- sudden decrease of pressure on IUPC
- maternal sensation of a “pop”
Complications of epidural
-maternal hypotension secondary to decreased SVR –> decreased placental perfusion –> fetal bradycardia
Risks of general anesthesia
- maternal aspiration
- hypoxia to mom and fetus during induction
What is the difference between an epidural and a spinal?
Spinal is given in a one-time dose directly into the spinal canal leading to more rapid onset of anesthesia (used more in C/S)
What is the cause of demise in placental abruption?
hypoxia resulting from decreased placental surface area and maternal hemorrhage
Presentation of fetal vessel rupture
vaginal bleeding w/ sinusoidal variation of FHR indicative of anemia
How is hydration a helpful tocolytic?
dehydrated pt –> increased ADH –> binds oxytocin receptors (bc ADH is similar shape to oxytocin) –> contractions
How do beta-mimetics work as tocolytics?
increase level of cAMP –> Ca2+ sequestered into SR –> decreases contractions
Ritodrine and terbutaline are…
beta-mimetics
How do prostaglandin inhibitors work as tocolytics?
- prostaglandins increase intracellular levels of Ca2+
- indomethacin (NSAID that blocks the enzyme COX and decreases level of prostaglandin) is used as a tocolytic
What are the 4 types of pelvis?
- Gynecoid
- Android
- Anthropoid
- Platypelloid (more likely to have persistent OT position and lead to transverse arrest of labor)
3 etiologies of prolonged FHR decelerations
- preuterine: maternal hypotension, hypoxia
- uteroplacental: abruption, infarct, hemorrhaging previa
- postplacental: cord prolapse, compression, rupture of fetal vessel
What is the Rubin maneuver and what is it used for?
- used to deliver infant w/ shoulder dystocia
- place pressure on accessible shoulder to push it toward anterior chest wall of fetus to decrease bisacromial diameter and free impacted shoulder
What is Wood’s corkscrew maneuver and what is it used for?
- used to deliver infant w/ shoulder dystocia
- apply pressure behind posterior shoulder to rotate infant and dislodge anterior shoulder
An insult leading to growth restriction prior to 20 weeks results in (symmetric/asymmetric) hyperplasia whereas an insult leading to growth restriction after 20 weeks results in (symmetric/asymmetric) hypertrophy
- prior to 20 weeks: symmetric
- after 20 weeks: asymmetric
What causes variable decels?
cord compression (likely from oligo)
How do you treat GBS in a woman who is allergic to penicillin?
cefazolin, clinda, vanc
What is the first step in management of recurrent variables?
maternal repositioning –> amnioinfusion
What is the optimal mode of delivery for twins when Twin A is breech and Twin B is vertex?
C-section
Management of PTL between 34 and 37wk includes…
betamethasone, Pcn if GBS+ or unknown
Management of PTL between 32 and 34wk includes…
betamethasone, tocolytics, Pcn if GBS+ or unknown
Management of PTL <32wk includes…
betamethasone, tocolytics, mag sulfate, Pcn if GBS+ or unknown
Retraction of the head, or “turtle sign,” is indicative of…
shoulder dystocia
_________ and _________ given to patients with PPROM can prolong the latency period by 5-7 days
ampicillin, erythromycin
Can false+ nitrazine tests occur?
yes - blood or semen can cause false+
How does magnesium sulfate work?
competes with Ca2+ for entry into cells
Antibiotic therapy with _________ and ________ given to women with PPROM prolongs latency by 5-7 days
ampicillin, erythromycin
What antibiotics are given when chorioamnionitis is suspected?
clindamycin, gentamycin
Hyponatremia, hypotension, and tachysystole are signs of ___________ toxicity
oxytocin
