Lecture 16: Obstetrical Complications Flashcards
Preterm birth is defined as what?
Birth that occurs after 20 weeks but before 37 completed weeks of gestation
The diagnosis of preterm labor is defined as what events?
- Uterine contractions accompanied with cervical change
OR
- Cervical dilation of 2cm and/or 80% effaced
Which ethnicity is 2x more likely to experience pre-term labor?
African Americans 2x more likely than Caucasians
There is a link between infection and progressive changes in cervical length and how is this related to preterm labor?
Risk of PTL ↑ as cervical length ↓
What are 2 screening tools that can be used to assess cervical length and to better predict risk of PTL?
- Ultrasound for routin screen of cervical length
- Fetal fibronectin (FFN) released from BM’s of fetal membranes in response to disruption of the membranes as w/ uterine activity, cervical shortening or infection
Which tocolytic used for PTL is only used on a short-term basis (mostly for extreme prematurity)?
Indomethacin
What are NSAIDs (Ibuprofen) used for in regards to PTL?
- Used to ↓ uterine activity
- NOT used for primary treatment of preterm labor
Glucocorticoids are given for fetal lung maturation between what weeks?
Between 24 weeks and 34 weeks gestation
A single course of betamethasone is recommended for pregnant women between which weeks of gestation if at risk of PTL within 7 days and who have no received a previous corse of antenatal corticosteroids?
Between 34 0/7 week and 36 6/7 weeks of gestation
What are some of the preventative measures being used for PTL?
- IM progesterone (Makena) given weekly from 16-36 weeks in women w/ prior hx of spontaneous PTL/PPROM
- Vaginal progesterone used in women w/ shortened cervix (<2.5 cm)
- Pessary (Arabin pessary) used in women w/ shortened cervix
Diagnosis of premature rupture of membranes (PROM) is based on what; confirmed how?
- History! —> loss of fluid + confirmation of amniotic fluid in vagina
- Rupture is confirmed using a sterile speculum
What should you never do when assessing a presumed ruptured preterm patient?
Do NOT check the cervix —> ↑ risk of infection especially w/ prolonged latency before delivery
What are 3 tests that can be done to confirm PROM?
- Pooling
- Nitrazine paper (turns blue)
- Ferning
Management of PPROM depends on what 4 factors?
- Gestational age at time of rupture: if <24 wks may lead to pulmonary hypoplasia
- Amniotic fluid index: any value <5cm is considered oligohydramnios
- Fetal status
- Maternal status
What is the goal of management for PPROM?
Continue the pregnancy until lung profile is mature
Regardless of fetal lung maturity, most women with PPROM will deliver at how many weeks gestation?
34 weeks
While managing woman with PPROM you must monitor for signs/sx’s of chorioamnionitis, which include what?
- Maternal temp >100.4 °F
- Fetal or maternal tachycardia
- Tender uterus
- Foul smelling amniotic fluid/purulent discharge
ACOG recommends using what drugs to attempt to prolong latency period of woman with PPROM?
- 48 hour course of IV Ampicillin and Erythromycin/Azithromycin
- Followed by 5 days of Amoxil and Erythromycin
What is the ACOG recommendation for use of steroids in patient with PPROM?
Use up to 34 weeks of gestation to ↓ risk of RDS
What is the primary screening tool used to assess/diagnose intrauterine growth restriction?
Serial fundal height measurements
If fundal height lags more than how many cm behind gestational age do you then order an ultrasound to assess intrauterine growth restriction?
Lags more than 3cm behind gestational age
What 2 things should be monitored after birth of a fetus that was subjected to IUGR?
- Neonatal blood glucose because these neonates have less hepatic glycogen stores
- Monitor respiratory status as RDS is more common
