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ENRP > Obstetrical Complications > Flashcards

Obstetrical Complications Flashcards

1
Q

What defines Preterm Labor (PTL)?

A

Between 20 and 36 weeks and 6 days

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2
Q

What is the general way to diagnose Preterm Labor?

A

Uterine contractions and cervical change

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3
Q

What is the very specific way to diagnose PTL?

A

Cervical dilation of at least 2 cm
AND/OR
80% effaced

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4
Q

What is the very specific way to diagnose Preterm Labor?

A

Cervical dilation of at least 2 cm
AND/OR
80% effaced

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5
Q

What are the 4 main pathways that are aimed at preventing PTL?

A
  1. Infection
  2. Placental-vascular
  3. Pyschosocial stress
  4. Uterine stretch
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6
Q

What are 4 infections that can increase the risk for PTL?

A

Bacterial Vaginosis
Group B strep
Gonorrhea
Chlamydia

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7
Q

Alterations in the placental-vascular flow can lead to what 2 things that are risk factors for PTL?

A

Preeclampsia

Poor fetal growth

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8
Q

What molecules that are increased with psychosocial stress can be a risk factor for PTL?

A

Cortisol

Catecholamines

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9
Q

In what race is PTL more common due to socioeconomic reasons?

A

Black people

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10
Q

The risk of PTL is INCREASED as cervical length is _____

A

DECREASED

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11
Q

As the cervical length is decreased, the risk for preterm labor is?

A

Increased

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12
Q

What are some symptoms of PTL?

A

Cramping/contractions
Backache
Discharge

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13
Q

With the evaluation of PTL, what may resolve the contractions?

A

Hydration and rest

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14
Q

With the evaluation of PTL, you should evaluate for infection and then what?

A

Hydrate

–> check cervix again in 1 hour

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15
Q

What are 3 drugs that can be used for Tocolysis if the patient is < 34 weeks?

A

Magnesium Sulfate
Nifedipine
Prostaglandin Synthetase inhibitors

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16
Q

What are 3 drugs that can be used for Tocolysis of PTL and how they are given?

A

Magnesium Sulfate (IV)
Nifedipine (oral)
Prostaglandin Synthetase Inhibitors – for extreme prematurity

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17
Q

What can be given between 24-34 weeks to help the fetal lungs mature?

A

Glucocorticoids

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18
Q

If a patient is at risk of PTL in the next 7 days and she is between 34-36 and 6, what can be given?

A

Single course of Betamethasone

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19
Q

What is the lower limit of Viability with a premie?

A

22-24 weeks

< 500 gms

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20
Q

What is PROM (premature rupture of membranes)?

A

Rupture of membranes before the onset of labor at any gestation

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21
Q

What is diagnosis of PROM made off of?

22
Q

What will the patient say in their history with PROM?

A

Loss of amniotic fluid in the vagina

23
Q

What should you NOT do with a presumed PROM patient?

A

Do NOT check the cervix!!!!

24
Q

Why should you not check the cervix of a presumed PROM patient?

A

Increased risk of infection since the amniotic sac may not be intact

25
What are 3 tests to confirm PROM?
1. Pooling 2. Nitrazine paper 3. Ferning
26
What are 3 tests to confirm PROM?
1. Pooling 2. Nitrazine paper 3. Ferning
27
With PROM, the nitrazine paper should turn what color?
Blue
28
What are some false (+)s and (-)s with the Nitrazine paper test for PROM?
False (+)s = urine, blood, semen | False (-)s = Minimal leakage or none remaining
29
Management of PROM depends on gestational age, amniotic fluid index and the status of mother/baby. When do most PROM patients deliver?
34 weeks
30
When do most PROM patients deliver and what should you monitor for?
34 weeks | -- monitor for chorioamionitis
31
IUGR
Intrauterine Growth Restriction
32
What defines IUGR?
Estimated fetal weight or abdominal circumference is below 10% for gestational age
33
What defines IUGR?
Estimated fetal weight or abdominal circumference is below 10% for gestational age
34
What are some maternal causes of IUGR?
Poor nutrition/low weight | Smoking and drugs
35
What is a placental cause of IUGR?
Insufficient substrate transfer through placenta or poor invasion
36
What are the TORCH infections of the fetus that can cause IUGR, amongst other things?
Toxoplasmosis Rubella CMV Herpes
37
What are the 2 main ways to diagnose IUGR?
Fundal height | Ultrasound
38
What are the 2 main ways to diagnose IUGR?
Fundal height | Ultrasound
39
How do you measure fundal height and when does it indicate IUGR?
Top of uterine fundus to pubic bone | = If the height lags more than 3cm behind what is expected for gestational age
40
Once IUGR is identified, what should be done weekly?
Nonstress test twice a week BPP Doppler of Umbilical A.
41
What finding on doppler of the Umbilical A. can signify IUGR?
Decreased diastolic flow
42
What defines Postterm Pregnancy?
Gestation > 42 weeks
43
Post - Maturity Syndrome is due to?
- due to aging/infarcts of the placenta especially near 42 weeks
44
What are the signs a baby had Post-Maturity Syndrome?
Decreased subcutaneous fat Long fingernails Dry and peeling skin Increased hair
45
What are the signs a baby had post-maturity syndrome?
Decreased subcutaneous fat Long fingernails Dry and peeling skin Increased hair
46
When is induction preferred with a Post-term pregnancy?
41 weeks preferred | -- Definitely induce by 42 weeks
47
IUFD
Intrauterine Fetal Demise
48
What defines IUFD?
Death after 20 weeks gestation but before labor onset
49
How do you diagnose IUFD?
Ultrasound with no fetal cardiac activity
50
What causes IUFD?
Usually known

ENRP (45 decks)

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