Obstetrical Complications (Wootton)

Question 1

Preterm Labor (PTL) definition

Answer 1

birth that occurs after 20 weeks but before 36 6/7 weeks

Question 2

Diagnosis for preterm labor

Answer 2

1. uterine contractions
2. cervical change
3. 2 cm and/or 80% effaced

Question 3

What are the 4 main pathways for prevention of preterm labor?

Answer 3

1. Infection (BV, GBS, gonorrhea/chlamydia)
2. Placental-vascular
3. Psychosocial stress and work strain (mental and physical stress)
4. Uterine stretch (polyhydramnios - increased amniotic fluid and multiple gestations - twins)

Question 4

The association between the cervix length and PTL

Answer 4

the relative risk for PTL is increased the shorter your cervix
** RR 6.2 for cervical length of 2.5 cm

Question 5

Screening tools for preterm labor (PTL)

Answer 5

US and fetal fibronectin (FFN)

Question 6

Evaluation for PTL

Answer 6

cervical exam to assess dilation, effacement and fetal presenting part; external monitoring and oral/IV hydration; cultures for group B strep

Question 7

Hydration in PTL

Answer 7

hydration and rest will resolve uterine contractions but will NOT stop PTL

Question 8

Management of PTL

Answer 8

if less than 34 weeks, start tocolysis:
Magnesium sufate - drug of choice
Nifedipine
Prostaglandin Synthetase Inhibitors`

Question 9

Drug of choice for PTL management when less than 34 weeks

Answer 9

Magnesium sufate; competes with calcium for entry into the cell at the same time of depolarization; provides some neuroprotection (against cerebral palsy)

Question 10

Nifedipine treatment in PTL

Answer 10

oral agent; inhibits/slows inward current of calcium during the second phase of the action potential

Question 11

Agent used in extreme prematurity of PTL

Answer 11

Prostaglandin Synthetase Inhibitors; inhibits prostaglandin production that induce myometrial contractions; use on short term basis; can result in oligohydramnios

Question 12

Agents for fetal lung maturation

Answer 12

glucocorticoids; effects last 7 days; single does of betamethasone is recommended for 34 - 36 weeks at risk for PTL within 7 days

Question 13

What are the lower limits of viability of a preterm infant?

Answer 13

22 weeks or 500 g

Question 14

Definition of premature rupture of membranes (PROM)

Answer 14

premature rupture of the membranes before the onset of labor at any gestational age

Question 15

premature rupture of membranes (PROM) diagnosis

Answer 15

hx: loss of fluid and confirmation of amniotic fluid in vagina
**DO NOT check the cervix; will increase risk of infection!
rupture is confirmed using a sterile speculum

Question 16

How is premature rupture of membranes (PROM) confirmed?

Answer 16

rupture is confirmed using a sterile speculum; AmniSure Test detects PAMG-I in amniotic fluid; can also confirm with pooling, nitrazine paper and ferning and an US

Question 17

Why do you NOT check the cervix is you suspect a premature rupture of membranes?

Answer 17

will increase risk of infection!

Question 18

What are some causes of false positives in nitrazine results?

Answer 18

urine, semen, cervical mucous, blood, vaginitis

Question 19

What are some causes of false negatives in nitrazine results?

Answer 19

remote PROM with no remaining fluid or minimal leakage

Question 20

What are the 4 things management of preterm prematurity rupture of membranes (PPROM) depend on?

Answer 20

1. gestational age
2. amniotic fluid index
3. fetal status
4. maternal status

Question 21

Most PPROM will deliver when?

Answer 21

at 34 weeks regardless of fetal lung maturity

Question 22

Antibiotic therapy for PPROM

Answer 22

48 hours of IV Ampicillin and Erythromycin/Azithromycin followed by 5 days of Amoxil and Erythromycin

Question 23

Use of steroids for PPROM

Answer 23

up to 34 weeks to reduce risk of respiratory distress syndrome (RDS)

Question 24

Importance of surfactant

Answer 24

necessary for lung function by decreasing alveolar surface tension and keeping alveoli open

Question 25

Intrauterine Growth Restriction (IUGR) definition

Answer 25

when the estimate fetal weight or abdominal circumference of a newborn is BELOW 10%

Question 26

Small for gestational age (SGA definition

Answer 26

BIRTH WEIGHT at the lower extreme of normal birth weight distribution

Question 27

What are the 3 main categories for causes of Intrauterine Growth Restriction (IUGR)?

Answer 27

1. maternal - smoking, drugs, alcohol, poor nutrition, teratogen exposure
2. placental - tiny vessels, decrease substrate transfer, decreased trophoblastic invasion
3. fetal - TORCH, congenital anomalies, chromosomal abnormalities

Question 28

Diagnosis of Intrauterine Growth Restriction (IUGR)?

Answer 28

fundal height (pubic bone to the top of the fundus) lags more than 3 cm behind the gestational age; then order an US

Question 29

What is the goal of Intrauterine Growth Restriction (IUGR) management?

Answer 29

deliver before fetal compromise but after fetal lung maturity

Question 30

What are the 5 components of the Biophysical Profile (BPP)

Answer 30

1. non stress test (NST
2. fetal breathing movements
3. fetal movements
4. fetal tone
5. amniotic fluid volume

Question 31

What should you monitor after birth of a ntrauterine Growth Restriction (IUGR) infant?

Answer 31

neonatal blood glucose (low hepatic glycogen stores) and respiratory status for RDS

Question 32

Definition of post-term pregnancy

Answer 32

a pregnancy that continues past 42 weeks; perinatal mortality is 2 to 3 times higher

Question 33

Postmaturity syndrome

Answer 33

related to aging and infarction of the placenta; loss of subcutaneous fat, long fingernails, dry and peeling skin and abundant hair

Question 34

Intrauterine Fetal Demise (IUFD) definition

Answer 34

fetal death after 20 weeks gestation, but before the onset of labor; most cases are unknown

Question 35

Diagnosis of Intrauterine Fetal Demise (IUFD)

Answer 35

patient complains of absence of fetal movements or if unable to detect on Doppler fetal heart tones confirm by US with lack of fetal activity and absence of fetal cardiac activity