Lecture 16: Obstetrical Complications Flashcards

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1
Q

Preterm birth is defined as what?

A

Birth that occurs after 20 weeks but before 37 completed weeks of gestation

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2
Q

The diagnosis of preterm labor is defined as what events?

A
  • Uterine contractions accompanied with cervical change

OR

  • Cervical dilation of 2cm and/or 80% effaced
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3
Q

Which ethnicity is 2x more likely to experience pre-term labor?

A

African Americans 2x more likely than Caucasians

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4
Q

There is a link between infection and progressive changes in cervical length and how is this related to preterm labor?

A

Risk of PTL ↑ as cervical length ↓

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5
Q

What are 2 screening tools that can be used to assess cervical length and to better predict risk of PTL?

A
  • 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
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6
Q

Which tocolytic used for PTL is only used on a short-term basis (mostly for extreme prematurity)?

A

Indomethacin

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7
Q

What are NSAIDs (Ibuprofen) used for in regards to PTL?

A
  • Used to ↓ uterine activity
  • NOT used for primary treatment of preterm labor
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8
Q

Glucocorticoids are given for fetal lung maturation between what weeks?

A

Between 24 weeks and 34 weeks gestation

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9
Q

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?

A

Between 34 0/7 week and 36 6/7 weeks of gestation

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10
Q

What are some of the preventative measures being used for PTL?

A
  • 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
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11
Q

Diagnosis of premature rupture of membranes (PROM) is based on what; confirmed how?

A
  • History! —> loss of fluid + confirmation of amniotic fluid in vagina
  • Rupture is confirmed using a sterile speculum
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12
Q

What should you never do when assessing a presumed ruptured preterm patient?

A

Do NOT check the cervix —> ↑ risk of infection especially w/ prolonged latency before delivery

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13
Q

What are 3 tests that can be done to confirm PROM?

A
  • Pooling
  • Nitrazine paper (turns blue)
  • Ferning
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14
Q

Management of PPROM depends on what 4 factors?

A
  1. Gestational age at time of rupture: if <24 wks may lead to pulmonary hypoplasia
  2. Amniotic fluid index: any value <5cm is considered oligohydramnios
  3. Fetal status
  4. Maternal status
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15
Q

What is the goal of management for PPROM?

A

Continue the pregnancy until lung profile is mature

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16
Q

Regardless of fetal lung maturity, most women with PPROM will deliver at how many weeks gestation?

A

34 weeks

17
Q

While managing woman with PPROM you must monitor for signs/sx’s of chorioamnionitis, which include what?

A
  • Maternal temp >100.4 °F
  • Fetal or maternal tachycardia
  • Tender uterus
  • Foul smelling amniotic fluid/purulent discharge
18
Q

ACOG recommends using what drugs to attempt to prolong latency period of woman with PPROM?

A
  • 48 hour course of IV Ampicillin and Erythromycin/Azithromycin
  • Followed by 5 days of Amoxil and Erythromycin
19
Q

What is the ACOG recommendation for use of steroids in patient with PPROM?

A

Use up to 34 weeks of gestation to ↓ risk of RDS

20
Q

What is the primary screening tool used to assess/diagnose intrauterine growth restriction?

A

Serial fundal height measurements

21
Q

If fundal height lags more than how many cm behind gestational age do you then order an ultrasound to assess intrauterine growth restriction?

A

Lags more than 3cm behind gestational age

22
Q

What 2 things should be monitored after birth of a fetus that was subjected to IUGR?

A
  • Neonatal blood glucose because these neonates have less hepatic glycogen stores
  • Monitor respiratory status as RDS is more common