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ENRP Exam 1 > Obstetric Complications - Dr. Wootton > Flashcards

Obstetric Complications - Dr. Wootton Flashcards

1
Q

Preterm Labour qualifications

A
  1. 20weeks -36 6/7 weeks

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

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2
Q

Preterm Labour risks with who

A
  1. AA,

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

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3
Q

Prevention of PTL 4 ways

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

What infections do you treat to prevent PTL

A
  1. BV
  2. Group B strep
  3. Gonorrhea + Chlamydia
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5
Q

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

A
  1. 4cm
  2. 2.4 higher risk
  3. 6.2 higher risk
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6
Q

Fetal Fibronectin (FFN)

A 
- = good
\+ = PLT is possible, ( something is disrupting membranes)
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7
Q

Reasons placenta might not implant properly

A
  1. Low spiral artery resistance connection
  2. Vascular problem, immune problem
    = increase chance of PTL + Preeclampsia
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8
Q

Stress affects PTL how

A
  1. Cortisol release = early placental cortiotrophin releasing hormone (CRH) = assist in Labour
  2. Catecholamines = BF changes + contractions
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9
Q

What to evaluate in to coming in with PTL

A

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)

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10
Q

Manage PTL under 34 weeks

A
  1. TOCOLYSIS (Mg Sulfate, Nifedipine, PGE Inhibitor= Indomethicin)
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11
Q 
MG sulfate 
1. How you give it
2. MOA
3. Good for 
4.
A

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)

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12
Q

Mg sulfate

1. Side effects

A
  1. Warm flush, N,V, Respiratory depression, low muscle tone, drowsy neonate ,Lower Apgar scores neonate
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13
Q

Nifedipine

  1. Given how
  2. MOA
  3. Side effects
A
  1. Oral, drug of choice
  2. Inhibits Ca+ into cells
  3. HA, Hypotension, tachy, flushing (minimal)
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14
Q

PGE synthase inhibitors

  1. Works how
  2. Used when
  3. Types used and how to give
  4. Side effects
A
  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
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15
Q

PTL and glucocorticoids are given for what

A

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

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16
Q

Lowest week and weight you can deliver a baby

A

22-24 weeks,, 500gms

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17
Q

Drugs to prevent PTL

A
  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
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18
Q

PROM

1. is what

A
  1. Premature Rupture of Membrane, PPROM (preterm, premature rom)
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19
Q

PROM risks

A
  1. Infection s
  2. Short cervix
  3. Low BMI
  4. Smoking, low nutrition
  5. 2nd ,3rd trimester bleeding
20
Q

What do you NOT do in PROM

A

DONT check cervix = infection can happen

= just inspect fluid with sterile speculum

21
Q

AmniSure Test

A

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

22
Q

Confirming PROM is done with what 3 things

A
  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,
23
Q

False + in nitrazine paper Turning blue

A
  1. BV

2,. Blood, seen BM urine, cervical mucous

24
Q

False - in nitrazine paper Turing blue

A
  1. No remaining fluid

2. Very little leakage

25
Q

Management of PPROM

A
  1. If under 24 weeks, fetus will have pulmonary hypoplasia + structural anomalies
  2. Under 5cm = oligohydramnios
26
Q

Goal of managing PPROM

A
  1. Deliver after lung development
  2. Usually delivery at 34 weeks no mater what the lung development is
    Unless chorioamnionitis then deliver earlier
27
Q

Chorioamnionitis SX

A
  1. Mother Fever over 100.4F
  2. . tachy mom or fetus
  3. Tender uterus
  4. Foul smelling amniotic fluid or discharge
28
Q

TX Chorioamnionitis

A
  1. 48 hours IV Ampicillin + erythromycin/Azithromycin

2. Then 5 days Amoxil + erythromycin

29
Q

Steroids are used for what weeks

A

Up to 34 weeks

30
Q

IUGR Intrauterien Fetal Growth Restriction

  1. What
  2. Risks
A
  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
31
Q

3 main things that cause low fetal growth

A
  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
32
Q

TORCH

A

Toxoplasmosis, other, Rubella, CMV, Herpes

33
Q

How to DX IUGR

A
  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
34
Q

US measurements

A 
1. Biparietal diameter (BPD)
2, head
3. Abd
4. Femor to abd
4. Umbilical + Uterine A Doppler
35
Q

IUGR fetus gets what 3 tests weekly

A
  1. NST 2 times a week
  2. Biophysical profile
  3. Doppler study of Umbilical A
36
Q

Reactive NST for over 32 weeks + under 32 weeks

A

15bpm over baseline for 15 sec

Under 32 weeks = 10bpm over baseline for 10 sec

37
Q

Biophysical Profile involves 5 things

A
  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)
38
Q

Doppler study is done when

A

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

39
Q

When to do something about IUGR

A

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

40
Q

IUGR fetus when born what do you monitor

A

Glucose level, lower hepatic glucose stores, respiration

41
Q

Post Term PREG

A

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

42
Q

Reasons of post term preg

A
  1. Fetal adrenal hypoplasia
  2. Anencephalic fetus (missing part of Brian)
  3. Placental sulfatase deficiency (X-linked)
  4. Extrauterine preg
43
Q

Postterm preg test for

A

Oligohydramnios, induce at 42weeks no matter what

44
Q

Intrauteriene Fetal Demise IUFD

A

Fetal death after 20weeks

45
Q

IUFD dx

A

Doppler fetal heart tones, US confirm no fetal movements

46
Q

IUFD management

A

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

ENRP Exam 1 (13 decks)

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