Obstetrical Complications Flashcards
How do we diagnose preterm labor?
Uterine contractions with cervical dilation of 2cm and/or 80% effaced
4 socioeconomic risk factors for PTL?
African American
Limited access to health care
High stress levels
Poor nutrition
What are the 4 main pathways of prevention of PTL?
Infection, placenta vascular, stress and work strain and uterine stretch
What is the inflection cervical pathway?
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.
What is the relationship of cervical length and risk and what is an additional screening tool for cervical shortening/PTL risk?
Shorter it gets, the more risk.
Fetal fibronectin is released when the fetal membranes are disrupted.
Explain the placental-vascular pathway and how it leads to PTL?
Any disruptions in the placenta-decidual-myometrial interface can result in poor fetal growth which can lead to PTL
Explain the stress-strain pathway and how it can lead to PTL?
Mental and physical stress release cortisol and catecholamines which can cause uterine contractions and labor
2 conditions that can lead to the uterine stretch pathway leading to PTL?
Polyhydramnios
Multiple gestation
5 symptoms of preterm labor?
Cramping Low back pain Pelvic pressure Bloody discharge Uterine contractions
First 4 things to do in the initial management of PTL?
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
2 things resolve contractions in about 20% of patients, what are they? What 2 things do you do next if contractions don’t stop?
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
What 3 meds do yo give once the diagnosis of PTL is made? which one is the drug of choice in US?
Magnesium sulfate (drug of choice) Nifedipine Prostaglandin synthesis inhibitors (Indomethacin)
4 side effects of magnesium sulfate to mom?
Flushing, NV, respiratory distress and cardiac arrest at high levels
3 side effects to baby from magnesium sulfate?
Loss of muscle tone
Drowsy
Lower Apgar scores
Some studies show magnesium sulfate may be important in the role of what? What is the route of admin for it as well?
Neuroprotection
IV
Route of admin for nifedipine, and 4 side effects?
Oral
Headache, flushing, hypotension, tachycardia
What is the most common prostaglandin synthetase inhibition and what are 4 side effects to baby?
Oligohydramnios, premature closure of ductus arteriosus leading to pulmonary HTN and heart failure, necrotizing enterocolitis and intracranial hemorrhage
When are glucocorticoids usually given for baby lungs?
Between 24 and 34 weeks
What is the exception to the 24-34 week rule?
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
What is the lower limit of viability and what is the preferred way of delivery?
24 weeks or 500 grams
If head is down, vaginal. If breech, c section.
What did she say is the most recent intervention for preventing PTL? 3 things?
IM Progesterone
Vaginal progesterone
Arabin pessary
4 risk factors for premature rupture of the membranes?
Infections
Abnormal membranes
Incompetent cervix
Nutritional deficiencies
What do you not do with a patient who you think has ruptured membranes?
Don’t check cervix because it can lead to infection
Why would you suspect a lady has ruptured membranes, 2 things?
She tells you loss of fluid and amniotic fluid in vagina
3 test to confirm rupture?
Pooling, nitrazine paper (turns blue) and Ferning.
What are 5 false positives to the nitrazine test?
Urine, semen, cervical mucous, blood and vaginitis
So what is the big thing we are worried about with premature rupture of the membranes?
Because the amniotic sac is a barrier to infection, we are worried about infection leading to PTL
What are we worried about if rupture happens before 24 weeks?
Pulmonary hypoplasia
What amniotic fluid index is oligohydramnios?
Less than 5
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?
Continue pregnancy until fetal lung maturation Infection Mom has temp over 100.4 Tachycardia Uterine tenderness Foul smelling amniotic fluid
What is the antibiotic recommendation for infection of premature rupture of membranes?
48 hours of IV ampicillin and erythromycin followed by 5 days of amoxicillin and erythromycin
