lecture 7: obstetrical complications, wootten

Question 1

preterm birth is defined as birth that occurs

Answer 1

after 20 weeks but before 37

Question 2

risk factors of PTL

Answer 2

socioeconomic
-stress, af americans, poor nutrition

medical and obstetrical factors

• spont abortions
• bleeding first trimester
• UTI
• multiple gestations
• uterine abnormalities
• polyhydramnios
• others

Question 3

prevention of PTL aimed at 4 main pathways

Answer 3

infection
placental-vascular
psychosocial stress and work strain
uterine stretch

Question 4

infection cervical path

Answer 4

bacterial vaginosis causes PTL

treat group B strep with antibiotics, also treat gonorrhea, and chlamydia

Question 5

relative risk of PTL incresases as cervical length ___

Answer 5

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)

Question 6

alteration of placental vascular pathway

Answer 6

results in poor fetal growth which is a risk factor for PTL

Question 7

stress strain pathway

Answer 7

increase cortisol and catecholamines

Question 8

uterine stretch pathway risk factor in what

Answer 8

polyhydramnios

multiple gestations

Question 9

diagnosis of PTL

Answer 9

20-37 weeks

1) uterine contractions
2) cervical change: cervical dilation of 2 cm or greater and/or 80% effacement

Question 10

symptoms of PTL

Answer 10

menstrual like cramp
dull backache
pelvic pressure
increase in discharge/blood discharge and uterine contractions

Question 11

management of PTL

Answer 11

initially assess cervix for dilation, effacement and fetal presenting part

evaluate for correctable problems like infection

external monitor fetal heart rate

reevaluate cervix

Question 12

after checking then what for management PTL

Answer 12

hydration and bed rest will resolve contractions in 20% of pts

cultures taken for group B strep and give Abs empirically

get US

Question 13

if no response to IV hydration and rest or diagnosed 2 cm and or 80% effaced then what?

Answer 13

tocolysis

• MgSO4- (drug of choice)
• nifedipine
• prostaglandin synthetase inhibitors (indomethicin)

Question 14

dose of MgSO4

role in what

Answer 14

6 gm load IV then 3 gm/hour continuous maintenance

important in role of neuroprotection

Question 15

prostaglandin synthetase inhibitors used when

Answer 15

used on short term basis

-mostly for extreme prematurity (less than 28 weeks)

Question 16

glucocorticoids for fetal lung maturation when do give

Answer 16

24 and 34 weeks

Question 17

prevention of PTL

Answer 17

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

Question 18

risk factors for premature rupture of membrane (PROM)

Answer 18

infections
abnormal membranes
incompetent cervix
nutritional deficiencies

Question 19

diagnosis of PROM

Answer 19

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

Question 20

confirmation of PROM

Answer 20

pooling
nitrazine paper turns blue
ferning

Question 21

conservative expectant managment of PPROM

goal and monitor for

diagnosis of second one made by

drugs

Answer 21

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

Question 22

definition of intrauterine growth restriction

IUGR

Answer 22

birth weight of newborn is below the 10% for a given gestational age

Question 23

IUGR etiology

Answer 23

maternal
placental
fetal

Question 24

maternal IUGR etiology

Answer 24

drugs/alcohol/cigs

blood and heart conditions

Question 25

placnetal causes of IUGR

Answer 25

insufficient substrate transfer through placenta

HTN, renal disease, DM, cord abnormalities can cause placental insufficiency

Question 26

fetal causes of IUGR

Answer 26

infections
congenital anomalies
multiple gestation
chrom abnormalities

Question 27

diagnosis IUGR

Answer 27

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

Question 28

doppler study umbilical artery

Answer 28

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

Question 29

if US shows IUGR and greater than 38-39 weeks then what

what if less than that

Answer 29

deliver

antenatal testing, if normal, continue preg
-if abnormal then deliver

Question 30

what do you need to monitor in the fetus after birth in IUGR

Answer 30

continuous fetal monitoring
neonatal blood glucose
respiratory status

Question 31

prognosis for baby IUGR

Answer 31

greater risk for adult onset diabetes, HTN, atherosclerosis