Obstetric Complications - Dr. Wootton

Question 1

Preterm Labour qualifications

Answer 1

1. 20weeks -36 6/7 weeks

2. Uterine contractions + cervical changes OR cervical dilation of 2cm OR 80% effaced

Question 2

Preterm Labour risks with who

Answer 2

1. AA,

2. UTI, second trimester abortion, repeated 1st trimester abortion, Polyhydramnois, bleeding 1st trimester

Question 3

Prevention of PTL 4 ways

Answer 3

1. infection (cervical) (tx infection)
2. Placental/vasculature. (Fix implantation)
3. Stress and work strain
4. Uterine Stretch ( anomalies or polyhydramnios, many gestations )

Question 4

What infections do you treat to prevent PTL

Answer 4

1. BV
2. Group B strep
3. Gonorrhea + Chlamydia

Question 5

Normal Cervical length and risk in 3.5cm and 2.5cm for PTL

Answer 5

1. 4cm
2. 2.4 higher risk
3. 6.2 higher risk

Question 6

Fetal Fibronectin (FFN)

Answer 6

- = good
\+ = PLT is possible, ( something is disrupting membranes)

Question 7

Reasons placenta might not implant properly

Answer 7

1. Low spiral artery resistance connection
2. Vascular problem, immune problem
   = increase chance of PTL + Preeclampsia

Question 8

Stress affects PTL how

Answer 8

1. Cortisol release = early placental cortiotrophin releasing hormone (CRH) = assist in Labour
2. Catecholamines = BF changes + contractions

Question 9

What to evaluate in to coming in with PTL

Answer 9

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)

Question 10

Manage PTL under 34 weeks

Answer 10

1. TOCOLYSIS (Mg Sulfate, Nifedipine, PGE Inhibitor= Indomethicin)

Question 11

MG sulfate 
1. How you give it
2. MOA
3. Good for 
4.

Answer 11

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)

Question 12

Mg sulfate

1. Side effects

Answer 12

1. Warm flush, N,V, Respiratory depression, low muscle tone, drowsy neonate ,Lower Apgar scores neonate

Question 13

Nifedipine

1. Given how
2. MOA
3. Side effects

Answer 13

1. Oral, drug of choice
2. Inhibits Ca+ into cells
3. HA, Hypotension, tachy, flushing (minimal)

Question 14

PGE synthase inhibitors

1. Works how
2. Used when
3. Types used and how to give
4. Side effects

Answer 14

1. PGE stopping causing stop in myometrial contractions
2. Short term only for extreme prematurity (24 weeks)
3. Indomethacin oral/rectal
4. Oligohydramnios, PDA, pulm HTN, HF, necrotizing enterocolitis, intracranial hemorrhage

Question 15

PTL and glucocorticoids are given for what

Answer 15

Fetal lung development to mature all the way (betamethasone, dexamethasone)
= lasts 7 days ,
= up to 37 weeks

Question 16

Lowest week and weight you can deliver a baby

Answer 16

22-24 weeks,, 500gms

Question 17

Drugs to prevent PTL

Answer 17

1. P injection (Makena, 16week to 36 week weekly) = previous PROM, or spontaneous PTL
2. Vaginal P for cervix under 2.5cm
3. Pessary = not favorable for short cervix

Question 18

PROM

1. is what

Answer 18

1. Premature Rupture of Membrane, PPROM (preterm, premature rom)

Question 19

PROM risks

Answer 19

1. Infection s
2. Short cervix
3. Low BMI
4. Smoking, low nutrition
5. 2nd ,3rd trimester bleeding

Question 20

What do you NOT do in PROM

Answer 20

DONT check cervix = infection can happen

= just inspect fluid with sterile speculum

Question 21

AmniSure Test

Answer 21

Tests for Amniotic fluid in PROM, detecting PAMG-1, can be affected with a lot of blood

Question 22

Confirming PROM is done with what 3 things

Answer 22

1. Pooling by cervix is seen
2. Fluid on nitrazine paper turns blue
3. Ferning (on slide and let dry and it looks like a fern plant)
   = can also use US,

Question 23

False + in nitrazine paper Turning blue

Answer 23

1. BV

2,. Blood, seen BM urine, cervical mucous

Question 24

False - in nitrazine paper Turing blue

Answer 24

1. No remaining fluid

2. Very little leakage

Question 25

Management of PPROM

Answer 25

1. If under 24 weeks, fetus will have pulmonary hypoplasia + structural anomalies 2. Under 5cm = oligohydramnios

Question 26

Goal of managing PPROM

Answer 26

1. Deliver after lung development 2. Usually delivery at 34 weeks no mater what the lung development is Unless chorioamnionitis then deliver earlier

Question 27

Chorioamnionitis SX

Answer 27

1. Mother Fever over 100.4F 2. . tachy mom or fetus 3. Tender uterus 4. Foul smelling amniotic fluid or discharge

Question 28

TX Chorioamnionitis

Answer 28

1. 48 hours IV Ampicillin + erythromycin/Azithromycin | 2. Then 5 days Amoxil + erythromycin

Question 29

Steroids are used for what weeks

Answer 29

Up to 34 weeks

Question 30

IUGR Intrauterien Fetal Growth Restriction 1. What 2. Risks

Answer 30

1. Weight or abd circumference is under 10% normal + birth weight when born is lower extreme(SGA) 2. Meconium aspiration, Hypoxia, polycythemia, hypoglycemia, dm, cad,, HTN

Question 31

3 main things that cause low fetal growth

Answer 31

1. Maternal : poor nutrition, smoking, alcohol, Pulm insufficiency, collagen problem, APL 2. Placental : bad tranfer INTO placenta, defective trophoblast invasion (HTN, renal disease, DM, can cause this) 3. Fetal : infection, conenital, many gestation, chr problem

Question 32

TORCH

Answer 32

Toxoplasmosis, other, Rubella, CMV, Herpes

Question 33

How to DX IUGR

Answer 33

1. Feudal height : top of uterus from pubic bone ( same number of cm as weeks, lower then 3cm get US) 2. US biometry * most common* 3. Amniocentesis 4. Doppler study

Question 34

US measurements

Answer 34

``` 1. Biparietal diameter (BPD) 2, head 3. Abd 4. Femor to abd 4. Umbilical + Uterine A Doppler ```

Question 35

IUGR fetus gets what 3 tests weekly

Answer 35

1. NST 2 times a week 2. Biophysical profile 3. Doppler study of Umbilical A

Question 36

Reactive NST for over 32 weeks + under 32 weeks

Answer 36

15bpm over baseline for 15 sec | Under 32 weeks = 10bpm over baseline for 10 sec

Question 37

Biophysical Profile involves 5 things

Answer 37

1. reactive NST 2. Fetal breathing : 1 in 30sec for 30min 3. Fetal movement : 3 in 30min 4. Fetal tone : extend and flex back : 1 in 30min 5. Amniotic fluid (AFI) : over 2cm good (8-10 is normal, under 5 is problem)

Question 38

Doppler study is done when

Answer 38

When there is IUGR, to see how fetus is doing, ESP revered is very bad

Question 39

When to do something about IUGR

Answer 39

Under 3rd percentile = deliver at 37 weeks, reverse or absent umbilical A flow = deliver earlier = use glucocorticoid if under 37 weeks

Question 40

IUGR fetus when born what do you monitor

Answer 40

Glucose level, lower hepatic glucose stores, respiration

Question 41

Post Term PREG

Answer 41

Over 42 weeks, Postmaturity syndrome ( infarction and aging of placenta, dry peeling skin) , macrosomia —> shoulder dystocia

Question 42

Reasons of post term preg

Answer 42

1. Fetal adrenal hypoplasia 2. Anencephalic fetus (missing part of Brian) 3. Placental sulfatase deficiency (X-linked) 4. Extrauterine preg

Question 43

Postterm preg test for

Answer 43

Oligohydramnios, induce at 42weeks no matter what

Question 44

Intrauteriene Fetal Demise IUFD

Answer 44

Fetal death after 20weeks

Question 45

IUFD dx

Answer 45

Doppler fetal heart tones, US confirm no fetal movements

Question 46

IUFD management

Answer 46

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