Obstetric Complications - Wootton Flashcards
Pre-term labor is between weeks ___ and ___
20 - 37
Preterm labor is defined by what 2 things?
- Uterine contractions
- Cervical change/dilation
Causes of preterm labor
- Spontaneous
- Multiple gestations
- PPROM
- Pregnancy HTN
- Cervical incompetence
- Uterine anomalies
- Antepartum hemorrhage
- Intrauterine growth restriction
Does previous history of pre-term labor play a risk for the next pregnancy?
YES
Infections that can cause PTL
BV, B strep, gonorrhea, chlamydia
Cervical length and PTL
How to screen for this?
Shorter cervical length (2.5 cm) is a 6x risk for PTL compared to a normal (4 cm) length
Ultrasound
What is fetal fibronectin?
Released from BM of fetal membranes, means that PTL could happen for some reason
Placenta and PTL
Sign in mom?
Abnormal placental connection to mom for some reason, increases risk of PTL
Mom may get HTN, trying to push more blood through the placenta
Stress and PTL
Modifiers of this
Hight stress = high cortisol = high CRH from placenta = increased contractions
Stress reduction, good nutrition
Uterine stretch and PTL
Risk factors for this pathway
Uterine stretch via increasing volume –> contraction
Polyhydramnios, twins/triplets
Symptoms of PTL
Menstrual-like cramping, low/dull backache, pelvic pressure, increased discharge, uterine contractions
Managing PTL (4)
- Assess cervix
- Look for underlying causes
- Monitor uterus and fetal HR
- Re-evaluate after hydration
What main underlying cause for PTL is looked for?
Treat?
Group B strep (and other infections)
Empirical treatment = Penicillin (until negative culture)
If uterine contractions cannot be stopped with hydration and rest, and PTL is definitely happening, do what? (3)
Tocolytics
- MgSO4 + steroids
- Nifedipine
- Indomethicin
Benefit of MgSO4 outside of tocolytic effect
Prevents from cerebral palsy
Mom gets MgSO4 as tocolytic for PTL, develops warmth, flushing, N/V, respiratory depression. How to correct?
Calcium gluconate
Baby - side effects of MgSO4
- Lost muscle tone
- Drowsiness
- Lower Apgar scores
Nifedipine - MoA
Inhibits slow inward Ca++ flow during phase 2 of AP
Indomethacin - used usually when?
Side effects? (baby)
Extreme PTL (2nd trimester)
- Oligohydramnios (decreased baby’s renal function)
- Premature DA closure (3rd trimester)
When are glucocorticoids given for fetal lung maturation?
Give what?
Reduces what?
23-34 weeks
Betamethasone or Dexamethasone
RDS
Lowest limit of viability for PTL
23-24 weeks
Most recent intervention for preventing PTL
Used in who?
IM Progesterone (Makena) and Vaginal Progesterone (Prometrium)
Spontaneous PTL/PPROM
Arabin pessary - used when?
Women w/ shortened cervix
Risk factors for PROM
- Infections
- Abnormal membranes
- Incompetent cervix
- Nutritional deficiencies
Diagnosing PROM (history)
What NOT to do?
Loss of fluid, amniotic fluid in vagina
Touch the cervix w/ hands (prevent infection)
4 things to confirm PROM
- Pooling of amniotic fluid in vagina
- Nitrazine paper (turns blue)
- Ferning
- Ultrasound for fluid level
PPROM before 24 weeks…
- Complication?
Pulmonary hypoplasia (no fluid to breathe in and help lungs develop)
Oligohydramnios - AFI
Less than 5 cm
Diagnosing chorioamnionitis (4)
- Maternal fever ( >100.4)
- Fetal/maternal tachycardia
- Tender uterus
- Foul-smelling amniotic fluid
Traditional testing for fetal lung maturity
Mature lung – L:S?
If PG is present?
- Lecithin:sphingomyelin ratio
- Phosphatidylglycerol (PG)
L:S > 2
Considered mature
NEW testing for fetal lung maturity
Lamellar body number density (> 46,000)
What is IUGR? Definition?
Intrauterine growth restriction – birth weight of newborn is below 10% for given age
Maternal causes of IUGR
Anything that affects placental blood flow
- INFECTION (TORCH, etc.)
- Smoking
- Drugs
- Alcohol
- Heart disease
- Pulmonary insufficiency
- APA syndrome
- Thrombophilias
- Collagen vascular disease
IUGR – fundal height
Do what?
More than 3 cm behind gestational age
Order ultrasound - check for HTN, renal disease, DM, drugs, APA, SLE, etc.
