Lecture 1 - Complications of Labor Flashcards
How many weeks pregnancy does “Term” refer to?
37-42 wks
What does Preterm labor mean?
regular contractions occurring at least every 10min resulting in cervical change prior to 37 wks.
Under what weight is condsidered Low Birth Weight (LBW)?
Any infant < 2500g at birth
Under what weight is considered Very Low Birth Wt (VLBW)?
< 1500g
**At 29 wks gestation, >90% of expected fetal weight is < 1500g
What is the survival rate for infants born at:
< 24wks?
>30wks?
>34wks?
24 wks ~10%
30 wks >90%
34 wks > 98%
Survival of an infant can increase by _____% each day between 25-26 wks
5% per day
__________ __________ __________ will affect almost all infants < 27wks gestational age.
Resp Distress Syndrome
Besides resp distress syndrome, what are some other problems that affect premature infants?
sepsis, Nec enterocolitis, Intracranial hemorrhage, Ischemic cerebral damage, immature metabolism (prolong Rx effects), hypoglycemia, hyperbilirubinemia
What are some causes of preterm Labor?
Group B strep
Neisseria Gonorrhea
Bacterial Vaginosis
***antibiotics can prevent preterm labor with some success
Will having a preterm baby delivered C-section prevent intracranial hemorrhage?
No
Will use of forceps for vaginal delivery increase the chances of intracranial hemorrhage in a preterm infant?
No
For a preterm infant that is breech, what delivery method is prefered, C-section or vaginal birth?
C-section
What can an epidural help prevent in PTL?
Avoid preciptous delivery
Decrease risk of ICH
Avoid maternal pushing agains an incomplete cervix
What are some indications for Tocolytic Therapy?
Gestation age 20-34 wks
EFW < 2500g
Absence of fetal distress
Does Tocolytic therapy reduce morbidity if used long-term?
No, but it does permit corticosteroid treatment to aid fetal lung development if used for 48hrs or less or allow for transfer to a facility with a NICU.
Tocolytic therapy - problem with using Ethanol?
causes intoxication, LOC, aspiration
**no longer used because there’s better drugs out there
Tocolytic therapy - problem using methylxanthines (aminophylline, phosphodiesterase)?
Narrow therapeutic margin and frequent toxic side effects
Tocolytic therapy - Calcium channel blockers - side effects?
Hypotension, tachycardia, dizzy, palpitation
facial flushing
vasodilation, peripheral edema
Myocardial depression, conduction defects
Hepatic dysfunction
Postpartum hemorrhage
Fetal side effects
Decreased UBF –> fetal hypoxemia and fetal acidosis
Calcium channel blockers - major concern?
pt more prone to cardiac depressant effects of volatile agents
- increase risk of postpartum hemorrhage due to uterine atony refractory to oxytocin and prostaglandin F-a2
Tocolytic therapy - how does Indomethacin or Sulindac effect labor?
decreases cyclooxygenase –> decrease prostaglandin
Maternal side effects of indomethacin or sulindac?
Nausea
Heartburn
Transient dec. platelet aggregation –> bleeding
Primary pulmonary HTN
What are some side effects to the fetus from using indomethacin or sulindac?
Crosses placenta
Premature closure of ductusarteriosus
Persistent fetal circulation
Renal impairment, transient oliguria
Tocolytic Therapy - using Magnesium will have what affect on muscle relaxants? MAC?
Patient is more sensitive to both depolarizing and nondepolarizing muscle relaxants.
- MAC is decreased
What is the normal range of Mag during treatment?
4-7 mg/100ml
At what range would you expect loss of deep tendon reflexes when using Mag?
8-10
When using Mag, At what range would you expect respiratory depressing, cardiac conduction defects?
10-15
What are the cardiac conduction defects you would expect when Mag levels are high?
wide QRS and lengthened PR interval
When the Mag level reaches 20 or more, what would you expect?
Cardiac arrest
What is the treatment of Mag overdose?
Calcium gluconate or CaCl
Tocolytic therapy - when using Terbutaline or Ritodrine (Beta agonists) what side effects are common?
N/V
Anxiety, restlessness
Hyperglycemia, hyperinsulinemia, hypokalemia, acidosis
Tachycardia, arrhythmias, dec peripheral VR, Edema
PULMONARY EDEMA (1-5%)
Fetal mortality risk is ____ to _____ times greater for twins vs single births
5-6
mother carrying multiple babies is at no different risk of hemorrhage than single gestation mothers?
UNTRUE - please place a large bore IV in multiple gestation mothers
What is a great drug for uterine relaxation during c-section for multiple gestation?
Nitroglycerin 100mcg initial repeated to dose of 500mcg max
What LA is preferred for use in mulitple gestation epidural?
2-chloroprocaine 3% preferred due to rapid onset
Signs and symptoms of Uterine Rupture
- Sudden abdominal pain despite functioning epidural
- Vaginal bleeding
- Hypotension
- Cessation of labor
- Fetal distress – most reliable sign
what are some risk factors associated with uterine rupture?
Previous uterine surgery Trauma Multiparity Uterine anomaly Oxytocin Placenta percreta Tumors Macrosomia Malposition
What is an absolute indication for having a c-section?
Transverse Lie
What does “presentation” refer to?
most dependent or presenting part of the infant
What does “Lie” refer to?
Long axis of infant (longitudinal vs transverse)
**most common is longitudinal (vertex or breech)
What position will have the greatest chance of uncomplicated spontaneous delivery?
Vertex position, flexed c-spine with chin to chest, Occiput anterior (face down)
What is the main cause of fetal demise?
cord accidents
What age is considered postmaturity?
42 wks
What are some complications of postmaturity?
decreased placental blood flow
umbilical cord compression
meconium staining
macrosomia, shoulder dystocia
What are some typical umbilical cord accidents?
prolapsed umbilical cord monoamniotic twins umbilical cord length (72cm) Cord entanglement (nuchal cord) Torsion
