Obstetric Complications - Dr. Wootton Flashcards
Preterm Labour qualifications
- 20weeks -36 6/7 weeks
2. Uterine contractions + cervical changes OR cervical dilation of 2cm OR 80% effaced
Preterm Labour risks with who
- AA,
2. UTI, second trimester abortion, repeated 1st trimester abortion, Polyhydramnois, bleeding 1st trimester
Prevention of PTL 4 ways
- infection (cervical) (tx infection)
- Placental/vasculature. (Fix implantation)
- Stress and work strain
- Uterine Stretch ( anomalies or polyhydramnios, many gestations )
What infections do you treat to prevent PTL
- BV
- Group B strep
- Gonorrhea + Chlamydia
Normal Cervical length and risk in 3.5cm and 2.5cm for PTL
- 4cm
- 2.4 higher risk
- 6.2 higher risk
Fetal Fibronectin (FFN)
- = good \+ = PLT is possible, ( something is disrupting membranes)
Reasons placenta might not implant properly
- Low spiral artery resistance connection
- Vascular problem, immune problem
= increase chance of PTL + Preeclampsia
Stress affects PTL how
- Cortisol release = early placental cortiotrophin releasing hormone (CRH) = assist in Labour
- Catecholamines = BF changes + contractions
What to evaluate in to coming in with PTL
1, fetal heart
2 .US, uterine activity
3. Look at cervix length , dilation, effacement every hour
4. give fluid if needed = can stop contractions 20%
5. Look for strep B and others (PNC tx)
Manage PTL under 34 weeks
- TOCOLYSIS (Mg Sulfate, Nifedipine, PGE Inhibitor= Indomethicin)
MG sulfate 1. How you give it 2. MOA 3. Good for 4.
IV (6g loading and 3g maintenance)
= competes for Ca+2
= titration down when contractions stop
3. Neuro protection from cerebral palsy (when risk of delivering within 7 days or under 32 weeks)
Mg sulfate
1. Side effects
- Warm flush, N,V, Respiratory depression, low muscle tone, drowsy neonate ,Lower Apgar scores neonate
Nifedipine
- Given how
- MOA
- Side effects
- Oral, drug of choice
- Inhibits Ca+ into cells
- HA, Hypotension, tachy, flushing (minimal)
PGE synthase inhibitors
- Works how
- Used when
- Types used and how to give
- Side effects
- PGE stopping causing stop in myometrial contractions
- Short term only for extreme prematurity (24 weeks)
- Indomethacin oral/rectal
- Oligohydramnios, PDA, pulm HTN, HF, necrotizing enterocolitis, intracranial hemorrhage
PTL and glucocorticoids are given for what
Fetal lung development to mature all the way (betamethasone, dexamethasone)
= lasts 7 days ,
= up to 37 weeks
Lowest week and weight you can deliver a baby
22-24 weeks,, 500gms
Drugs to prevent PTL
- P injection (Makena, 16week to 36 week weekly) = previous PROM, or spontaneous PTL
- Vaginal P for cervix under 2.5cm
- Pessary = not favorable for short cervix
PROM
1. is what
- Premature Rupture of Membrane, PPROM (preterm, premature rom)
PROM risks
- Infection s
- Short cervix
- Low BMI
- Smoking, low nutrition
- 2nd ,3rd trimester bleeding
What do you NOT do in PROM
DONT check cervix = infection can happen
= just inspect fluid with sterile speculum
AmniSure Test
Tests for Amniotic fluid in PROM, detecting PAMG-1, can be affected with a lot of blood
Confirming PROM is done with what 3 things
- Pooling by cervix is seen
- Fluid on nitrazine paper turns blue
- Ferning (on slide and let dry and it looks like a fern plant)
= can also use US,
False + in nitrazine paper Turning blue
- BV
2,. Blood, seen BM urine, cervical mucous
False - in nitrazine paper Turing blue
- No remaining fluid
2. Very little leakage
Management of PPROM
- If under 24 weeks, fetus will have pulmonary hypoplasia + structural anomalies
- Under 5cm = oligohydramnios
Goal of managing PPROM
- Deliver after lung development
- Usually delivery at 34 weeks no mater what the lung development is
Unless chorioamnionitis then deliver earlier
Chorioamnionitis SX
- Mother Fever over 100.4F
- . tachy mom or fetus
- Tender uterus
- Foul smelling amniotic fluid or discharge
TX Chorioamnionitis
- 48 hours IV Ampicillin + erythromycin/Azithromycin
2. Then 5 days Amoxil + erythromycin
Steroids are used for what weeks
Up to 34 weeks
IUGR Intrauterien Fetal Growth Restriction
- What
- Risks
- Weight or abd circumference is under 10% normal + birth weight when born is lower extreme(SGA)
- Meconium aspiration, Hypoxia, polycythemia, hypoglycemia, dm, cad,, HTN
3 main things that cause low fetal growth
- Maternal : poor nutrition, smoking, alcohol, Pulm insufficiency, collagen problem, APL
- Placental : bad tranfer INTO placenta, defective trophoblast invasion (HTN, renal disease, DM, can cause this)
- Fetal : infection, conenital, many gestation, chr problem
TORCH
Toxoplasmosis, other, Rubella, CMV, Herpes
How to DX IUGR
- Feudal height : top of uterus from pubic bone ( same number of cm as weeks, lower then 3cm get US)
- US biometry * most common*
- Amniocentesis
- Doppler study
US measurements
1. Biparietal diameter (BPD) 2, head 3. Abd 4. Femor to abd 4. Umbilical + Uterine A Doppler
IUGR fetus gets what 3 tests weekly
- NST 2 times a week
- Biophysical profile
- Doppler study of Umbilical A
Reactive NST for over 32 weeks + under 32 weeks
15bpm over baseline for 15 sec
Under 32 weeks = 10bpm over baseline for 10 sec
Biophysical Profile involves 5 things
- reactive NST
- Fetal breathing : 1 in 30sec for 30min
- Fetal movement : 3 in 30min
- Fetal tone : extend and flex back : 1 in 30min
- Amniotic fluid (AFI) : over 2cm good
(8-10 is normal, under 5 is problem)
Doppler study is done when
When there is IUGR, to see how fetus is doing, ESP revered is very bad
When to do something about IUGR
Under 3rd percentile = deliver at 37 weeks, reverse or absent umbilical A flow = deliver earlier
= use glucocorticoid if under 37 weeks
IUGR fetus when born what do you monitor
Glucose level, lower hepatic glucose stores, respiration
Post Term PREG
Over 42 weeks, Postmaturity syndrome ( infarction and aging of placenta, dry peeling skin) , macrosomia —> shoulder dystocia
Reasons of post term preg
- Fetal adrenal hypoplasia
- Anencephalic fetus (missing part of Brian)
- Placental sulfatase deficiency (X-linked)
- Extrauterine preg
Postterm preg test for
Oligohydramnios, induce at 42weeks no matter what
Intrauteriene Fetal Demise IUFD
Fetal death after 20weeks
IUFD dx
Doppler fetal heart tones, US confirm no fetal movements
IUFD management
Only up to 28 weeks watch (due to coagulopathy risk)
= then cervical ripening of PGEm laminar is, Misoprostol, oxytocin
= order antenatal testing for these patients
