obestrertical complications Flashcards
what to do if you suspect IUGR:
- 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
How to prevent preterm labor via the infection-cervical pathway
- bacterial vaginosis is assoc with pre term labor- teat to reduce incidence
- women in preterm labor should be tx with abx for group B strep which increases risk
- tx gonorhhea or chlamydia cervical infections
*link between infections and decrease in cervical length which increases the risk for pre term labor
4 pathways of prevention of preterm labor
I SUP
- infection (cervical)
- placental vascular
- uterine stretch
- stress and work strain
what are the 3 main etiologies of IUGR
- maternal (preventing NL vascular flow )
- placental (inadequate transfer/ insufficiency)
- fetal (infections -TORCH )
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)
tocolytics: (reduce contractions)
1. Mg sulfate (increases risk of PPH with uterine atony)
2. nifedipine (oral)
3. prostaglandin synthetase inhibitors (indomethcicin)
IUGR vs LGA definition
IUGR = birthweight < 10 % LGA = birthweight is lower limit of NL, usually < 20%
lower limit of viability in preterm infant
23 weeks or 500gms
how to confirm the dx of PROM
3 tests:
- AF pooling in vagina
- nitrazine paper to check pH (should turn BLUE)
- see ferning
(may also US to eval AF volume to aid dx)
GDM vs chronic DM risks for fetal birthweight
GDM: macrosomia
chronic DM : IUGR
define preterm birth? and dx of preterm labor
preterm birth: 20-36 weeks
dx:
1. uterine contractions
2. cervical change or dilation of 2cm or 80% effaced
which tocolytic is also neuroprotective and can serve as seizure prophylaxis in preeclampisa
Mg. Sulfate (IV)
big risk factors for IUGR seen commonly
HTN
DM
Renal Dz
SLE and Anti PLS
what is the caution with examining women with indication of PROM
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
most PPROM pts delivery at ___ regardless of fetal lung maturity
34 weeks
what is rule of thumb with use of glucocorticoids for fetal lung maturation in women at risk of preterm labor
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)
what is the stress-strain pathway that increases the risk of pre term labor, how to tx it
- stress induces the release of cortisol and catecholamines
- cortisol increases the release of CRH which induces labor
- catecholamines affects uterine blood flow (constriction) therefore can induce contractions
- tx with stress reduction and good nutrition
PROM vs PPROM
PROM = premature rupture of membranes before the onset of labor at ANY gestational age
PPROM = preterm premature rupture of membrane (between 20-36 weeks)
Leading cause of infant mortality
prematurity
what is the primary screening tool for IUGR
*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)
how to manage PPROM
- 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)
how to screen for cervical length (risk factor for pre term labor)
- US (esp if hx of CKC or LEEP)
- Fetal fibronetin (FFN) released from BM of fetal membranes in response to membrane disruption with uterine activity, shortening, or infection
(good negative predictive value)
management of IUGR in pre-pregnancy and antepartum care
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
what are the TORCH infections and what is the risk they carry
toxoplasmosis, other infections, rubella, cytomegalovirus, herpes
- risk of IUGR (via fetal pathway)
- do titers for TORCH infections
causes of postterm pregnancy (>42 weeks)
- unsure dates
- fetal adrenal hypoplasia
- anencephaly
___ and ___ will resolve contractions (not labor) in about 20% of women at risk of pre term labor
bed rest and hydration
