Obstetrical Complications

Question 1

How do we diagnose preterm labor?

Answer 1

Uterine contractions with cervical dilation of 2cm and/or 80% effaced

Question 2

4 socioeconomic risk factors for PTL?

Answer 2

African American
Limited access to health care
High stress levels
Poor nutrition

Question 3

What are the 4 main pathways of prevention of PTL?

Answer 3

Infection, placenta vascular, stress and work strain and uterine stretch

Question 4

What is the inflection cervical pathway?

Answer 4

Pregnant lady gets bacterial vaginitis from group b strep or chlamydia or gonorrhea infection and it changes cervical length which is a predictor for preterm birth risk.

Question 5

What is the relationship of cervical length and risk and what is an additional screening tool for cervical shortening/PTL risk?

Answer 5

Shorter it gets, the more risk.

Fetal fibronectin is released when the fetal membranes are disrupted.

Question 6

Explain the placental-vascular pathway and how it leads to PTL?

Answer 6

Any disruptions in the placenta-decidual-myometrial interface can result in poor fetal growth which can lead to PTL

Question 7

Explain the stress-strain pathway and how it can lead to PTL?

Answer 7

Mental and physical stress release cortisol and catecholamines which can cause uterine contractions and labor

Question 8

2 conditions that can lead to the uterine stretch pathway leading to PTL?

Answer 8

Polyhydramnios

Multiple gestation

Question 9

5 symptoms of preterm labor?

Answer 9

Cramping
Low back pain
Pelvic pressure
Bloody discharge
Uterine contractions

Question 10

First 4 things to do in the initial management of PTL?

Answer 10

Check the cervix fo dilation and effacement
See if there is an underlying issue like infection
External monitoring for uterine activity and fetal HR
Give IV fluids and after an hour check cervix

Question 11

2 things resolve contractions in about 20% of patients, what are they? What 2 things do you do next if contractions don’t stop?

Answer 11

Cultures taken for group b, chlamydia, gon. Give antibiotics for GBS and discontinue if negative
US to rule out too much fluid or baby problems

Question 12

What 3 meds do yo give once the diagnosis of PTL is made? which one is the drug of choice in US?

Answer 12

Magnesium sulfate (drug of choice)
Nifedipine
Prostaglandin synthesis inhibitors (Indomethacin)

Question 13

4 side effects of magnesium sulfate to mom?

Answer 13

Flushing, NV, respiratory distress and cardiac arrest at high levels

Question 14

3 side effects to baby from magnesium sulfate?

Answer 14

Loss of muscle tone
Drowsy
Lower Apgar scores

Question 15

Some studies show magnesium sulfate may be important in the role of what? What is the route of admin for it as well?

Answer 15

Neuroprotection

IV

Question 16

Route of admin for nifedipine, and 4 side effects?

Answer 16

Oral

Headache, flushing, hypotension, tachycardia

Question 17

What is the most common prostaglandin synthetase inhibition and what are 4 side effects to baby?

Answer 17

Oligohydramnios, premature closure of ductus arteriosus leading to pulmonary HTN and heart failure, necrotizing enterocolitis and intracranial hemorrhage

Question 18

When are glucocorticoids usually given for baby lungs?

Answer 18

Between 24 and 34 weeks

Question 19

What is the exception to the 24-34 week rule?

Answer 19

Single course of betamethasone is recommended for pregnancy patients between 34 and 36 weeks when baby will be born within 7 days who were not previously given corticoids

Question 20

What is the lower limit of viability and what is the preferred way of delivery?

Answer 20

24 weeks or 500 grams

If head is down, vaginal. If breech, c section.

Question 21

What did she say is the most recent intervention for preventing PTL? 3 things?

Answer 21

IM Progesterone
Vaginal progesterone
Arabin pessary

Question 22

4 risk factors for premature rupture of the membranes?

Answer 22

Infections
Abnormal membranes
Incompetent cervix
Nutritional deficiencies

Question 23

What do you not do with a patient who you think has ruptured membranes?

Answer 23

Don’t check cervix because it can lead to infection

Question 24

Why would you suspect a lady has ruptured membranes, 2 things?

Answer 24

She tells you loss of fluid and amniotic fluid in vagina

Question 25

3 test to confirm rupture?

Answer 25

Pooling, nitrazine paper (turns blue) and Ferning.

Question 26

What are 5 false positives to the nitrazine test?

Answer 26

Urine, semen, cervical mucous, blood and vaginitis

Question 27

So what is the big thing we are worried about with premature rupture of the membranes?

Answer 27

Because the amniotic sac is a barrier to infection, we are worried about infection leading to PTL

Question 28

What are we worried about if rupture happens before 24 weeks?

Answer 28

Pulmonary hypoplasia

Question 29

What amniotic fluid index is oligohydramnios?

Answer 29

Less than 5

Question 30

What is the goal of expectant management of premature rupture of membranes and as we monitor what are we worried about and what are the 4 symptoms of it?

Answer 30

Continue pregnancy until fetal lung maturation
Infection
Mom has temp over 100.4
Tachycardia
Uterine tenderness
Foul smelling amniotic fluid

Question 31

What is the antibiotic recommendation for infection of premature rupture of membranes?

Answer 31

48 hours of IV ampicillin and erythromycin followed by 5 days of amoxicillin and erythromycin