MTB 2 Flashcards
MC used tocolytic
Magnesium Sulfate
AE’s of Magnesium Sulfate
Flushing, HA, diplopia, fatigue
What do we check when administering Magnesium Sulfate
DTRs
Magnesium toxicity - respiratory depression and cardiac arrest
Complications with PROM
Preterm labor
Cord prolapse
Placental abruption
Chorioamnionitis
What is the Tx of PROM w chorioamnionitis
Obtain cervical cultures
Broad spectrum IV Abx
Deliver immediately
Pt presents w fever, maternal tachycardia, fetal tachycardia, maternal leukocytosis, uterine tenderness, foul smelling amniotic fluid?
Chorioamnionitis
Tx of PROM at term, no Chorioamnionitis
Wait 6-12 hours for spontaneous delivery.
If does not occur - Induce labor
Tx of Preterm fetuses w/out Chorioamnionitis
- Betamethasone
- Tocolytics
- Amp and Gent
What is placenta previa
Abnormal implantation of placenta over internal cervical os
Presentation of placenta previa
Third trimester painless bleeding
Usually after 28 wks
Pt presents with bleeding, no CTX, no pain, stable. Next step?
Transabdominal US
What is CI in third trimester bleeding
DRE
TV US
What is the tx for placenta previa
If large volume bleeding/drop in Hct
- Strict pelvic rest w nothing in vagina
Indications for immediate C-section in placenta previa
- Unstoppable labor (cervical dilation > 4 cm)
- Severe hemorrhage
- Fetal distress
What is placental abruption
Premature separation of placenta from uterus
Risk factors for placental abruption
Maternal HTN
Prior placental abruption
Cocaine
Trauma
Dx test for placental abruption
Transabdominal US
Types of placental abruption
Concealed - completely detached, serious complications
External - partially detached, smaller w/minimal complications
Tx for placental abruption
C-section or Vaginal delivery
Uterine rupture presentation
Sudden extreme abdominal pain
Abdominal bump
No uterine CTX
Regression of fetus
Risk factors for uterine rupture
Previous C section Trauma - MVAs Uterine myomectomy Uterine overdistension - polyhydramnios, multiple gestations Placenta percreta
Tx for uterine rupture
Immediate laparotomy w delivery of fetus
Rh Incompatibility
Mother - Rh Negative
Baby - Rh Positive
First baby delivered -> fetal RBCs cross placenta into mother’s bloodstream . Mother makes abs against Rh positive blood
Hemolytic Dz of the NB presentation
Fetal anemia - extramedullary production of RBCs
Increased heme and BR in plasma
When is prenatal antibody screening done?
28 weeks
35 weeks
When is BP above 140/90 gestational HTN?
When it starts after 20 week
What is the difference b/t mild and severe preeclampsia
Mild >140/90, 1+ proteinuria, 24 hr urine >300 mg, Edema in hands/feet/face
Severe >160/110, 3+ proteinuria, 24 hr urine > 5 g, Generalized edema, mental status changes, vision changes, impaired liver fnc
Tx of gestational HTN
ONLy during pregnancy w
Labetolol
methyldopa
Nifedipine
What is eclampsia
Preeclampsia + seizures
Tx for preeclampsia if Near term
Delivery!
Seizure control with magnesium sulfate
BP control w/hydralazine or IV labetolol
HELLP Syndrome
Hemolysis
Elevated Liver enzymes
Low platelets
Liver manifestations seen with HELLP
Centrilobar necrosis
hematoma
Thrombi in portal capillary system
- Swelling of liver w/distension of hepatic capsule that causes (Glisson’s) pain
Complications with pregestational Diabetes - Maternal
Spontaneous abortion - 2X
Preeclampsia - 4X
Increased rate of Infxn
Increased risk of PPH
Complications with pregestational Diabetes - Fetal
Congenital anomalies - Heart - NTDs Macrosomia - Shoulder dystocia - Preterm
Which diabetes medication is not used in pregnancy
Sulfonyureas
What tests are done at 32-36 wks
Weekly NST
US
What tests are done at > 36 weeks
Twice weekly:
One NST
One BPP
What tests are done at 37 weeks
L:S ratio
What tests are done at 38-39 weeks
None.
Induction of labor
Complications seen with gestational diabetes
Preterm birth fetal macrosomia and birth injuries Fetal hypoglycemia Pyelonephritis Meconium aspiration Still birth
When is screening for gestational diabetes
Between 24-28 weeks
Glucose load test: if above 140 then
Glucose tolerance test: if any are elevated, confirmed
Tx for gestational diabetes
- Diet and Exercise
- Insulin w NPH if
- fasting > 95
- one hour postprandial > 140
What drugs cross placenta to cause fetal hyperinsulinemia
Sulfonyureas:
Chlorpropamide
Tolbutamide
Tx for preeclampsia if severe and far from term
Monitor closely inpatient Maintain BP < 155/105 If using Labetolol IV, DBP < 90 MgSO4 - seizures PPX Induce as soon as fetus is considered viable
What is mild preeclampsia? Severe preeclampsia?
Mild = BP > 140/90 Severe = 160/110
