lecture 7: obstetrical complications, wootten Flashcards
preterm birth is defined as birth that occurs
after 20 weeks but before 37
risk factors of PTL
socioeconomic
-stress, af americans, poor nutrition
medical and obstetrical factors
- spont abortions
- bleeding first trimester
- UTI
- multiple gestations
- uterine abnormalities
- polyhydramnios
- others
prevention of PTL aimed at 4 main pathways
infection
placental-vascular
psychosocial stress and work strain
uterine stretch
infection cervical path
bacterial vaginosis causes PTL
treat group B strep with antibiotics, also treat gonorrhea, and chlamydia
relative risk of PTL incresases as cervical length ___
decreases
-use US to see length
also use fetal fibronectin
- released in response to disruption of membranes
- negative predictive value is good (if negative then not in labor, but positive predictive value is poor)
alteration of placental vascular pathway
results in poor fetal growth which is a risk factor for PTL
stress strain pathway
increase cortisol and catecholamines
uterine stretch pathway risk factor in what
polyhydramnios
multiple gestations
diagnosis of PTL
20-37 weeks
1) uterine contractions
2) cervical change: cervical dilation of 2 cm or greater and/or 80% effacement
symptoms of PTL
menstrual like cramp
dull backache
pelvic pressure
increase in discharge/blood discharge and uterine contractions
management of PTL
initially assess cervix for dilation, effacement and fetal presenting part
evaluate for correctable problems like infection
external monitor fetal heart rate
reevaluate cervix
after checking then what for management PTL
hydration and bed rest will resolve contractions in 20% of pts
cultures taken for group B strep and give Abs empirically
get US
if no response to IV hydration and rest or diagnosed 2 cm and or 80% effaced then what?
tocolysis
- MgSO4- (drug of choice)
- nifedipine
- prostaglandin synthetase inhibitors (indomethicin)
dose of MgSO4
role in what
6 gm load IV then 3 gm/hour continuous maintenance
important in role of neuroprotection
prostaglandin synthetase inhibitors used when
used on short term basis
-mostly for extreme prematurity (less than 28 weeks)
glucocorticoids for fetal lung maturation when do give
24 and 34 weeks
prevention of PTL
progesterone given weekly from week 16 to 36
used in women with previous history of PTL
vaginal progesterone (shortened cervix)
pessary-Arabin pessary
(women with short cervix
risk factors for premature rupture of membrane (PROM)
infections
abnormal membranes
incompetent cervix
nutritional deficiencies
diagnosis of PROM
loss of fluid and confirmation of amniotic fluid in vagina
DO NOT check cervix of presumed ruptured preterm pt. it increases the risk of infection especially with the prolonged latency before delivery
confirmation of PROM
pooling
nitrazine paper turns blue
ferning
conservative expectant managment of PPROM
goal and monitor for
diagnosis of second one made by
drugs
goal to continue pregnancy until lung profile is mature
monitor for chorioamnionitis
diagnosis made by: maternal temp over 100.4 fetal or maternal tachy tender uterus foul smelling amniotic fluid
give ampiclillin and erythromycin/azithromycin
definition of intrauterine growth restriction
IUGR
birth weight of newborn is below the 10% for a given gestational age
IUGR etiology
maternal
placental
fetal
maternal IUGR etiology
drugs/alcohol/cigs
blood and heart conditions
placnetal causes of IUGR
insufficient substrate transfer through placenta
HTN, renal disease, DM, cord abnormalities can cause placental insufficiency
fetal causes of IUGR
infections
congenital anomalies
multiple gestation
chrom abnormalities
diagnosis IUGR
serial fundal height measurement is primary screening tool
top of uterus to pubic bone
if more than 3 cm behind what should be then get US
doppler study umbilical artery
umbilical flow velocity waveform of normally growing fetus is characterized by high velocity diastolic flow
in IUGR there is diminution of umbilical artery diastolic flow
if US shows IUGR and greater than 38-39 weeks then what
what if less than that
deliver
antenatal testing, if normal, continue preg
-if abnormal then deliver
what do you need to monitor in the fetus after birth in IUGR
continuous fetal monitoring
neonatal blood glucose
respiratory status
prognosis for baby IUGR
greater risk for adult onset diabetes, HTN, atherosclerosis
