obstetrical complications- wootton Flashcards
what is the definition of pre-term labor?
birth that occurs after 20 weeks, but before 37 completed weeks of gestation
who is more likely to have a preterm labor?
poor african american women
what is the most common obstetrical complication?
preterm labor
what are the 4 pathways that are aimed at for preventing preterm labor
infection, placental vascular, stress/psychosocial, uterine stretch
which type of infection is amajor casue of preterm birth?
bacterial vaginosis
what is the relative risk as it relates to cervical length?
normal length= 4cm
RR of 2.4 for cervical length of 3.5 cm
RR of 6.2 for cervical length of 2.5cm
other than cervical length measuring, what is another screening test for preterm labor?
fetal fibronectin- if a negative test= good prognostic indication
what are some risks for increased risk of preterm labor in the uterine stretch pathway
increased volume due to polyhydramnios, multiple gestations
what MUST you have to diagnose preterm labor?
UTERINE CONTRACTIONS, and cervical change, dilation of 2 cm or greater and/or 80% effacement
how do you manage preterm labor?
evaluate the cervix, and then reevaluate in an hour, hydrate during that hour, correct any correctable causes ( infection)
what do you need to start with a preterm labor patient?
empiric penicillin treatment for group B strep, then culture and decide on course after results from culture
what do you give to PTL patients to slow the onset of labor/stop it, if it was less than 34 weeks gestation?
magnesium sulfate, or nifedipine
what is the dose of Mg sulfate you give for PTL?
6gram IV, then 3 gm /hour continuous
what is the general mechanism of action of Mg sulfte and nifedipine?
they both work on calcium during AP
what can you us in extremely premature babies, and can lead to premature closure of the ductus ateriousis?
protaglandin synthetase inhibitor- indomethicin
what can you use as an adjuvant in PTL?
NSAIDS
what is the lower limit of viability for a fetus in weeks and weight?
24 weeks, and 500 grams
what is premature rupture of membranse?
rupture of membranes before the onset of labor at any gestational age
should you check the cervix of a presumed ruptured preterm patient?
NO- increses the risk of infection
what are teh three tests you can use to confirm premature rupture of membranes?
pooling, nitrazine paper, ferning
what do you call it when there is less than 5 cm of amniotic fluid index?
oligohydramnios
what is the goal of treatment for preterm premature rupture of membranes?
continue pregnancy until lung profile is mature
when will most premature rupture pts deliver?
34 weeks
if a premature rupture patient presetns with the follwoing, what do you do? maternal temp over 100.4, fetal or maternal tachycardia, tender uterus, fould smelling discharge
deliver the baby
whater teh ACOG recomendations for PPROM pateints?
48 hours of ampicillin and erythromycin, then 5 days amoxil and erythromycin
no recomndation with tocolytics
use steroids up to week 32 for lung maturity
NO place for outpatient management
how do you test for fetal lung maturity?
L/S ratio- greater than 2= mature
presence of prostaglandin = mature
greater than 46,000 lamellar bodies= mature
what is intrauterine growth restriction?
birth weight of a newborn is below the 10% for a given gestational age
what are some maternal causes of IUGR?
poor nutrition, ciggarette, drug abuse, asthma,
what aer some placental causes of IUGR?
insufficient tansfer through the placenta–> HTN, renal disease, velamentous insertion of the cord
what re some fetal causes of IUGR?
TORCH infections,
is symetrical or asymmetrical IUGR more concerning?
asymmtrical, liver and pancreas undergo large changes in attempt to spare the brain
how do you monitor for IUGR?
serial fundal height measurements
if fundal height lags more than 3 cm behind the gestational age, order an ultrasound
what is the goal of managemnt of IUGR?
deliver before fetal compromise, but after lung maturity
what do you use doppler study of umbilical artery for?
Dx of IUGR, if the diastolic flow is decreased on doppler in the uterine artery= IUGR
is IUGR an indication for C section?
No, but teh fetus may not be able to handle delivery, so may get a C section anyway
what is a postterm pregnancy?
if it goes past 42 weeks
what type of babies tend to go past term?
anencaphaly, placental sulfatase deficiency, extra uterine pregnancy
how do you managment of of post term ?
biweekly testing of baby in 41st week, if abnormal- induce labor, or induce labor at 42 weeks
what do you suspect in a patient that comlains of absense of fetal movement or absense of fetal heart beat on ultrasound/
intrauterine fetal demise
