Obstetrical Complications (Wootton)

Question 1

Preterm birth is defined as a birth that occurs after __1__ weeks but before __2__ completed weeks of gestation.

Answer 1

1) 20 weeks

2) 36 6/7 weeks

Question 2

Diagnosis of preterm labor is __1__ accompanied with cervical change or cervical dilation of __2__ and/or __3__ effaced.

Answer 2

1) Uterine contractions
2) 2 cm
3) 80%

Question 3

What race is twice as more likely for preterm labor?

Answer 3

African American

Question 4

The prevention of preterm labor is aimed at what four main pathways?

Answer 4

1) Infection (cervical)
2) Placental-vascular
3) Psychosocial stress and work strain
4) Uterine stretch

Question 5

In the infection-cervical pathway what is associated with preterm delivery?

Answer 5

Bacterial Vaginosis

Question 6

In the treatment of women in preterm labor with antibiotics what infections do you want to make sure you treat for as they are a known risk factor for preterm labor?

Answer 6

Group B strep

Question 7

Bacterial vaginosis can increase the risk of cervical infections such as?

Answer 7

Gonorrhea and chlamydia

Question 8

What are screening tools of cervical length to assess risk of preterm labor?

Answer 8

1) Ultrasound

2) Fetal fibronectin

Question 9

Alteration of what components in the placental-vascular pathway may result in poor fetal growth which is a risk factor for preterm labor?

Answer 9

1) Immunologic component
2) Vascular component
3) Low resistance connection of spiral arteries

Question 10

In the stress-strain pathway, mental and physical stress are thought to induce a stress response that increases the release of __1__ and __2__.

Answer 10

1) Cortisol

2) Catecholamines

Question 11

Increased cortisol which is released from the adrenal glands can play a role in preterm labor because it stimulates increased __1__ levels which are known to assist in labor at term.

Catecholamines which affect blood flow can also play a role in preterm labor because they can cause __2__.

Answer 11

1) Corticotropin-releasing hormone (CRH)

2) Uterine contractions

Question 12

In the uterine stretch pathway, uterine stretch is secondary to ____ increasing?

What are risk factors?

Answer 12

1) Volume

2) Polyhydramnios and multiple gestations

Question 13

In the evaluation of preterm labor, what will resolve contractions in about 20% of patients?

Answer 13

Hydration and rest

Question 14

In the evaluation of preterm labor, cultures should be taken for?

Answer 14

1) Group B strep
2) Gardnerella
3) Gonorrhea and chlamydia

Question 15

Antibiotics are given, typically ____, to empirically treat for Group B strep and usually discontinued if culture negative.

Answer 15

Penicillin

Question 16

If diagnosed 2 cm and/or 80% effaced or made cervical change then begin tocolysis (if gestational age is less than 34 weeks and no contraindication). What are the options for tocolytic drugs?

Answer 16

1) Magnesium sulfate
2) Nifedipine
3) Prostaglandin Synthetase Inhibitors (indomethacin)

Question 17

__1__ is the tocolytic drug of choice in the U.S.

It acts on the cellular level and competes with __2__ for entry into the cell at the time of depolarization.

Typically a 6 gm loading dose is given __3__ and then a 3 gm/hour continuous maintenance.

Answer 17

1) Magnesium sulfate
2) Calcium
3) Intravenously

Question 18

Some recent studies have shown magnesium sulfate may be more important in the role of __1__.

It may offer prevention against __2__.

Answer 18

1) Neuroprotection

2) Cerebral palsy

Question 19

What maternal side effect may be seen with magnesium sulfate serum levels of 12-15 mg/dL?

What may be seen at high serum levels >30 mg/dL?

Answer 19

1) Respiratory depression

2) Cardiac conduction defects