Obstetrical Complications Flashcards
definition of preterm birth?
-occurs after 20 weeks but before 37 completed weeks of gestation
what are the four main pathways that we use to prevent PTL?
- Infection
- placental-vascular
- psychosocial stress and work strain
- uterine stretch
which abx do we treat women in preterm labor with?
-treat for group B strep
relative risk for PTL increases as ______ decreases?
- cervical length
- use that and fetal fibronectin as screening tools
diagnosis of PTL
- between 20 and 37 weeks gestation
- must have: 1.) uterine contractions, 2.) cervical change (dilation of 2 cm or 80% effacement)
how do we initially manage PTL?
hydration and bed rest will resolve contractions in about 20 % of patients
- culture for Group B strep
- fetal ultrasound
What do we do if there is no response to IV hydration and rest?
- begin tocolysis
- MgSO4
- Nifedipine
- PG synthetase inhibitors (indomethacin)
What does MgSO4 do?
- competes with Ca2+ for entry into cell at time of depolarization
- IV
NIfedipine
- Oral
- inhibits slow, inward current of calcium during second phase of the action potential
- suppresses PTL
Prostaglandin synthetase inhibitors
- Pg’s usually induce myometrial contractions… so we stop it
- Indomethacin is used
- maybe oligohydramnios
- greater risk of necrotizing enterocolitis for infant
what do we give to make the fetal lungs mature a little more?
- Betamethasone
- between 34 and 36 weeks at risk of preterm birth within 7 days
- have not received a previous course of antenatal corticosteroids
What mechanical thing is used in women with a shortened cervix to help prevent PTL?
-Arabin pessary
What is Premature rupture of membranes (PROM)?
-premature rupture of the membranes before the onset of labor at any gestational age
PROM diagnosis
- based on history
- loss of fluid
- confirmation of amniotic fluid in vagina
***What do we NOT do is we think there is a preterm infant in there with a presumed ruptrured membrane?
- Do NOT check the cervix
- it increases risk of infection especially with the prolonged latency before delivery
- rupture is confirmed using a sterile speculum
what will we see if there is PROM?
- pooling
- nitrazine paper turns blue
- ferning
What is PPROM?
-preterm premature rupture of membranes
What is the main goal of PPROM management?
-to continue preggo until lung profile is mature
What does ACOG recommend that we do for PPROM antibiotic usage?
-48 hour course of IV Ampicillin and Erythromycin/azithromycin followed by 5 days of Amoxil and Erythromycin
How long do we want to keep the baby in there at lesat to reduce the risk of RDS?
-34 weeks
What cells in the fetus produce surfactant?
-type 2 pneumocytes
What do we want the L/S ratio to be for fetal lungs?
- greater that 2
- Lecithin/Sphingomyelin
What means that the fetal lung is mature if it’s there?
-Phosphatyidyl glycerol (PG)
What is the rapid test for fetal lung maturity?
-the Lamellar body number density assessment (LBND)
