OB Labor & Delivery Complications

Question 1

Placenta Previa?

Answer 1

Placenta covers part of the internal cervical os.

Question 2

Symptoms of placenta previa?

Answer 2

Painless vaginal bleeding in 3rd trimester.

Question 3

Diagnose placenta previa?

Answer 3

Transabdominal Sonogram/

Question 4

Manage placenta previa?

Answer 4

if excessive, c-section.

Question 5

Preterm labor?

Answer 5

After 20 wks of labor but before 37 weeks of gestation.

Question 6

Diagnose preterm labor?

Answer 6

Documented regular uterine contraction (< 4.6/hour) and cervical change (effacement of 80% or cervical dilation of 3 cm or more).

Question 7

Manage preterm labor?

Answer 7

34 wks or more: Admit for delivery. and If after 4-6 hrs no cervical dilation or effacement and fetal well being assured, can be discharged.
< 34 wks: Admit for fetal monitoring. Give betamethasone. Tocolytics (Mag. sulfate) delay delivery up to 48 hrs to allow steroid to work and abx for GBS prophylaxis.

Question 8

Premature rupture of the membranes (PROM)?

Answer 8

Spontaneous rupture of membranes before onset of labor at any gestation causing maternal and fetal infx risk.

Question 9

Risk factors for PROM?

Answer 9

Vaginal and cervical infections
Smoking
Multiple gestations
Prior preterm delivery`

Question 10

Diagnosis of PROM?

Answer 10

Assess for cervical dilation and length with sterile speculum.

Question 11

Confirm PROM diagnosis?

Answer 11

1. Testing the fluid with Nitrazine paper, which will turn blue in the presence of the alkaline amniotic fluid
2. Looking at a sample of the fluid under a microscope and examining for “ferning.”

Question 12

Management of PROM?

Answer 12

Admit for fetal monitoring and await spontaneous labor. Monitor for infx. If does not occur prior to 18 hrs, then induce.

Question 13

Management of PPROM?

Answer 13

Admit for fetal monitoring.
If 34 weeks or less, give Betamethasone to enhance fetal lung maturity**
Tocolytics can be given to delay delivery up to 48 hours to allow the steroids to work (as long as not already 4 cm or more dilated, no sign of infection and no fetal distress.
Ampicillin & Azithromycin often given to prevent infection. Prompt delivery is required with any signs of maternal or fetal infection or distress.

Question 14

Dystocia?

Answer 14

Problem w/:
“POWERS” -> frequency or intensity of contractions is inadequate - the MOST COMMON
“PASSENGER” -> large fetal size; abnormal position, presentation or lie
“PASSAGE” -> maternal bony pelvic is too small or narrow to allow the infant’s passage

Question 15

Adequate labor?

Answer 15

200 Montevideo units (contraction force) for at least 2 hours. Thus, a patient having four contractions in 10 minutes, each with an amplitude of 50 mmHg.

Question 16

What is considered an arrest of labor?

Answer 16

no cervical change after 4 hours of adequate contractions (> 200 Montevideo units) or more than 6 hours with inadequate contractions

Question 17

Management for dystocia?

Answer 17

IV oxytocin for inadequate contractions.

Operative vaginal delivery or c-section if the baby is too big or in an abnormal position

Question 18

Risks of giving oxytocin?

Answer 18

Uterine rupture

Postpartum uterine atony & hemorrhage/