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CCP - Semester 2 > MFM > Flashcards

MFM Flashcards

1
Q

The biggest RF for PTL

A

Hx of spontaneous PTB, often occurs at the same GA or earlier

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2
Q

interventions to reduce PTL

A
  1. progesterone per vagina
  2. cerclage of cervix
  3. low dose asa
  4. removal of large fibroids
  5. ideally is 12-18m inter-pregnancy interval
  6. smoking cessation
  7. multifetal gestation
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3
Q

Causes of PTL

A
  1. Maternal stress
  2. Infection/inflammation
  3. Decidual Hemorrhage
  4. Pathologic Uterine Distention (Polyhydraminos, multiples)
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4
Q

True labour

A

Contractions that result in cervical change

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5
Q

Cervical change is defined as

A

dilation, effacement, softening, moving anterior

rate of cervival change important

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6
Q

Tocolytics are used for

A

Administration of a tocolytic rx can reduce the strength and frequency of uterine contraction

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7
Q

Tocolytic indications

A
  1. To try to reduce the strength/frequency of contractions.
  2. To delay/halt/prevent PTL
  3. To try to get to appropriate level of care for mother/fetus
  4. Used for 48hrs in Canada
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8
Q

Tocolytic medications

A
  1. Adalat (Nifedipine)
  2. indocid
  3. ventolin
  4. magnesum
  5. nitro patch
  6. terbutaline, ritodrine
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9
Q

Nifedipine (adalat)

A

used as a tocolytic for PTL (calcium channel blocker)
used in preeclampsia
evidence of benefit
less fetal harm
material s/s: n,v, hypotension, dizziness, h/a
you can use Nifedipine and magnesium together

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10
Q

Why use steroids in antenatal care?

A

Administration of antenatal corticosteroids to patients at risk for preterm birth reduces neonatal mortality when delivery occurs within 7 days help fetal lung develop

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11
Q

What steroids are given?

A

Betamethasone and dexamethasone

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12
Q

Chorioamnionitis definition

A

maternal fever >38 with tachycardia pulse signs of maternal sepsis
Tx: delivery and broad spectrum abx

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13
Q

Definition of preeclampsia

A

Resistant HTN with new/worsening proteinuria and adverse effects (H/A, Blurred vision, epigastric pain, IUGR, Oligo) after 20 weeks GA

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14
Q

Target organ damage in pre-eclampsia

A 
maternal = eclampsia, ICH, Pulmonary edema, liver
fetal = IUGR, oligo, abnormal doppler, abnormal EFM
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15
Q

criteria for blood pressure in preeclampsia

A 
≥140/≥90 = HTN
≥160/≥110 = Severe HTN
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16
Q

eclampsia is

A

a grand mal seizure with pre-eclampsia

17
Q

HELLP is

A

hemolysis elevated liver enzymes and low platelets. It represents a subtype of pre-eclampsia with severe features in which hemolysis, elevated liver enzyme and low platelets are the predominant features, rather than HTN or CNS/renal dysfunction.

18
Q

Preeclampsia indications for delivery

A
  1. worsening maternal status:
    - increasing bp
    - HELLP syndrome
    - eclampsia
    - increasing serum cr
    - abruption/DIC
  2. Compromised Fetal status
    - IUGR
    - Abnormal Doppler
    - oligohydramnios
19
Q

Treat pre-eclampsia with

A

Nefidapine, then labetalol

20
Q

Treat eclampsia with

A

4g of magnesium iv over 10-20 minutes

then 1g/hr for 24 hours

21
Q

important Hormones associated with maternal physiology

A
  1. progesterone
  2. prostaglandins
  3. oxytocin
  4. estrogen
  5. relaxin/cytokines and para-thyrpod hormones
22
Q

Factors inducing of labour

A
  1. fetus (HPA stress, cortisol)
  2. myometrial activation
  3. hormones
  4. membrane rupture
23
Q

how does indocin (indomethacin) work and why is it used as a tocolytic

A

Indacin inhibits the production of arachnoidic acid, which inhibits prostagland synthesis (used as a tocolytic)

24
Q

Benefits of oxytocin

A

○ Precursor produced in hypothalamus
○ Secreted from posterior pituitary in active labour
○ Oxytocin receptors are present on myometrium
§ Receptor increase near term
§ Receptors increased estradiol
§ Receptors down-regulated by progesterone
○ Oxytocin causes contractions by increasing intracellular calcium

25
Q

Five P’s of labor

A 
passage
passenger
power
position
psyche/partners
26
Q

treatment for short cervix

A

• Progesterone
• Cerclage
~Pessary

27
Q

Initial Assessment for <34 weeks gestation with symptoms of preterm labour

A
  1. Check gestational age
    1. Palpate contractions
    2. Sterile speculum exam:
      a. Cultures
      b. Rule out preterm ROM
      c. Take FFN Swab
      Perform digital assessment of CX
28
Q

Tocolytic Therapy goals

A
  • Delay delivery 24-48 hours if GA <34 weeks
    • Antibiotics: prevention of neonatal group B strep sepsis
    • Steroid therapy for prevention of neonatal RDS
    • Transport to appropriate centre for higher level of care if required
29
Q

Nifedipine MOA, dose and indications

A

MOA: calcium channel blocker
Dose: PTL = Loading dose of 10mg q 15 until contractions stop (4 doses max). Then XL dose

Indicated for: PTL, and for pre-eclampsia

30
Q

Preterm labour treatments:

A
  1. Betamethasone (corticosteroid for lung/gut/neuro protection)
  2. Tocoyltic (nifedipine, Indocin for meds to work/transport)
  3. Abx (Group B strep)
  4. Magnesium for fetal neuroprotection
31
Q

Consequences of PPROM

A 
• Preterm delivery
	• Fetal pulmonary hypoplasia
	• Fetal skeletal maldevelopment
	• Ascending infection
		○ Maternal sepsis
		○ Neonatal sepsis
Independent risk factor for cerebral palsy
32
Q

PPROM dx

A

Ferning and pH <7

33
Q

PPROM mgmt

A

• 24-34 weeks
• Ampicillin 2G IV q 6 h, erythromycin 250mg IV q6 h for 48hr
• Amoxicillin 250mg q 8h, erythromycin base 333mg q 8 hours for 5 days
• Single course of corticosteroids
• Monitor for signs of infection
• Monitor for signs for preterm labour
Deliver at 34-36 weeks, or when indicated

34
Q

difference between abx for PPROM and PTL or someone who has Group B strep

A
  1. PPROM abx essentially are used to keep baby inside so corticosteroids can work
  2. PTL/GROUP B strep is to prevent baby from getting septic during delivery from mom who has a high risk or has group b
35
Q

neonate risk of infection

A

• <37 weeks
• >18 hours PROM
• Intraamniotic infection
Previous affected neonate

36
Q

labs in HELLP

A 
• Hemolysis
		○ Peripheral smear w/ schistocytes and burr cells
		○ Bili >20mmol
		○ Low LDH, Low heptaglobin
		○ Severe anemia unrelated to blood loss 
	• HELLP 
		○ Two x upper limit of normal
Plts <100
37
Q

severe preeclampsia

A

>160/110
**preeclampsia before 34 weeks **
protein 3g/24h
(spot urine, cr protein ratio 250g/mol)

CCP - Semester 2 (14 decks)

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