obestrertical complications

Question 1

what to do if you suspect IUGR:

Answer 1

1. US
   - if NL no intervention
   - if IUGR + 38-39 wks, DELIVER
   - if IUGR + <38 wks, begin antenatal testing
   
   • if antenatal test is NL- continue pregnancy
   • if ABNL gets- DELIVER

Question 2

How to prevent preterm labor via the infection-cervical pathway

Answer 2

1. bacterial vaginosis is assoc with pre term labor- teat to reduce incidence
2. women in preterm labor should be tx with abx for group B strep which increases risk
3. tx gonorhhea or chlamydia cervical infections

*link between infections and decrease in cervical length which increases the risk for pre term labor

Question 3

4 pathways of prevention of preterm labor

Answer 3

I SUP

• infection (cervical)
• placental vascular
• uterine stretch
• stress and work strain

Question 4

what are the 3 main etiologies of IUGR

Answer 4

1. maternal (preventing NL vascular flow )
2. placental (inadequate transfer/ insufficiency)
3. fetal (infections -TORCH )

Question 5

if the gestational age is < 34 weeks and there is no contraindications, ____ is started for women who are 2cm dilated or 80% effaced (beginning of pre term labor)

Answer 5

tocolytics: (reduce contractions)
1. Mg sulfate (increases risk of PPH with uterine atony)
2. nifedipine (oral)
3. prostaglandin synthetase inhibitors (indomethcicin)

Question 6

IUGR vs LGA definition

Answer 6

IUGR = birthweight < 10 % 
LGA = birthweight is lower limit of NL, usually < 20%

Question 7

lower limit of viability in preterm infant

Answer 7

23 weeks or 500gms

Question 8

how to confirm the dx of PROM

Answer 8

3 tests:

1. AF pooling in vagina
2. nitrazine paper to check pH (should turn BLUE)
3. see ferning

(may also US to eval AF volume to aid dx)

Question 9

GDM vs chronic DM risks for fetal birthweight

Answer 9

GDM: macrosomia

chronic DM : IUGR

Question 10

define preterm birth? and dx of preterm labor

Answer 10

preterm birth: 20-36 weeks
dx:
1. uterine contractions
2. cervical change or dilation of 2cm or 80% effaced

Question 11

which tocolytic is also neuroprotective and can serve as seizure prophylaxis in preeclampisa

Answer 11

Mg. Sulfate (IV)

Question 12

big risk factors for IUGR seen commonly

Answer 12

HTN
DM
Renal Dz
SLE and Anti PLS

Question 13

what is the caution with examining women with indication of PROM

Answer 13

DO NOT CHECK the cervix of a presumed ruptured PRETERM patient because of the INCREASE RISK OF INFECTION esp with the prolonged latency before delivery

*rupture is confirmed with sterile speculum

Question 14

most PPROM pts delivery at ___ regardless of fetal lung maturity

Answer 14

34 weeks

Question 15

what is rule of thumb with use of glucocorticoids for fetal lung maturation in women at risk of preterm labor

Answer 15

a single course of bethamethasone at 34-36 weeks with risk of preterm labor within 7 days ( and who have not received a previous course of antenatal corticosteroids)

Question 16

what is the stress-strain pathway that increases the risk of pre term labor, how to tx it

Answer 16

1. stress induces the release of cortisol and catecholamines
2. cortisol increases the release of CRH which induces labor
3. catecholamines affects uterine blood flow (constriction) therefore can induce contractions
4. tx with stress reduction and good nutrition

Question 17

PROM vs PPROM

Answer 17

PROM = premature rupture of membranes before the onset of labor at ANY gestational age

PPROM = preterm premature rupture of membrane (between 20-36 weeks)

Question 18

Leading cause of infant mortality

Answer 18

prematurity

Question 19

what is the primary screening tool for IUGR

Answer 19

*serial fundal height on physical exam
(if fundal heigh lags >3 cm behind NL for age then do US)
(skip height and do US for those at high risk of IUGR)

Question 20

how to manage PPROM

Answer 20

• depends on gestational age, AF levels, and maternal-fetal status
• goal is to continue pregnancy until the lungs mature
• check for sx of chorioamnionitis bc causes earlier delivery
• can use ABX (prolong latency) or tocolytics (if no infection) or Steroids (lung maturity)

Question 21

how to screen for cervical length (risk factor for pre term labor)

Answer 21

1. US (esp if hx of CKC or LEEP)
2. Fetal fibronetin (FFN) released from BM of fetal membranes in response to membrane disruption with uterine activity, shortening, or infection
   (good negative predictive value)

Question 22

management of IUGR in pre-pregnancy and antepartum care

Answer 22

pre-pregnancy: optimize dz process (control DM /HTN)

ante-partum: decrease modifying factors (improve nutrition, stop smoking, bed rest)

• monitor NST biweekly, biophysical profile, doppler of umbilical A.
• *GOAL: deliver before fetal compromise but after fetal lung maturity

Question 23

what are the TORCH infections and what is the risk they carry

Answer 23

toxoplasmosis, other infections, rubella, cytomegalovirus, herpes

• risk of IUGR (via fetal pathway)
• do titers for TORCH infections

Question 24

causes of postterm pregnancy (>42 weeks)

Answer 24

1. unsure dates
2. fetal adrenal hypoplasia
3. anencephaly

Question 25

___ and ___ will resolve contractions (not labor) in about 20% of women at risk of pre term labor

Answer 25

bed rest and hydration