Obstetric Complications Flashcards
Preterm labor definiton
birth that occurs between 20w and 36w.
Before 20w= Miscarriage
After 36w= Full Term
What must be present to distinguish PTL from Intrauterine Fetal Demise (IUFD)?
Uterine Contractions and cervical change of 2cm and/or 80% effacement
4 pathways of prevention of PTL
- Prevent Infection
- Placental-vascular
- Reduce Stress/Strain
- Uterine stretch
What common bacterial infection is associated with PTL?
Bacterial Vaginosis (Gardnerella)
Other common infections to treat to prevent PTL due to link between infection and changes in cervical length
Gonorrhea
Chlamydia
How is cervical length related to risk of PTL?
Inverse relationship
Increased cervical length decreases PTL risk
Explain the link between maternal stress and PTL
Increased mental and physical stress induces release of cortisol and catecholamines.
This stimulates fetal CRH expression which assist in labor
Symptoms of PTL
cramping
LBP
Pelvic Pressure
bloody discharge
5 steps to evaluate for PTL
- Assess Cervix
- Look for underlying problems
- FHR
- Reevaluate Cervix hourly
- HYDRATE (resolves 20% of contractions)
What is the gestational age cutoff to administer tocolysis in order to start steroids for fetal lung development?
34 weeks
Side effects of Magnesium Sulfate
Flushing
NV
Respiratory Depression
Hyporeflexia
3 tocolytics used in management of PTL
MgSO4
Nifedipine
Indomethicin
Why does Indomethicin work as a tocolytic?
Prostaglandins induce myometrial contractions
A woman between 34w and 36w gestation at risk for PTL should be given what?
1 course of betamethasone
What is currently being studied as a preventative measure for risk of PTL?
Progesterone administration
What is PROM?
Premature Rupture of Membranes- rupture before labor
Why should you not check the cervix of a suspected PROM?
Increases risk of infection
Maternal Risks of PROM
Endomyometritis
Sepsis
Failed Induction
In a pregnancy with PROM, when does delivery usually occur regardless of fetal lung maturity?
34 weeks
Symptoms of Chorioamnionitis
Maternal Pyrexia
Tachycardia (fetal or maternal)
Uterine tenderness
Discharge
In a test for Fetal Lung Maturity, L/S ratio is measured at 1.4
What does this imply?
L/S ratio <2 is unfavorable and implies the fetal lungs are not mature
What is the Lamellar Body Number Density?
A measure of lamellar bodies that indicates fetal lung maturity.
What is Intrauterine Growth Restriction (IUGR)?
Birth weight below 10% for a given gestational age
Maternal causes of IUGR
Poor nutrition Cigarette smoking Drug Abuse Alcoholism APA
*Anything that decreases blood flow in mom i.e. vasoconstriction, atherosclerosis, etc.
