obstetrical complications- wootton

Question 1

what is the definition of pre-term labor?

Answer 1

birth that occurs after 20 weeks, but before 37 completed weeks of gestation

Question 2

who is more likely to have a preterm labor?

Answer 2

poor african american women

Question 3

what is the most common obstetrical complication?

Answer 3

preterm labor

Question 4

what are the 4 pathways that are aimed at for preventing preterm labor

Answer 4

infection, placental vascular, stress/psychosocial, uterine stretch

Question 5

which type of infection is amajor casue of preterm birth?

Answer 5

bacterial vaginosis

Question 6

what is the relative risk as it relates to cervical length?

Answer 6

normal length= 4cm
RR of 2.4 for cervical length of 3.5 cm
RR of 6.2 for cervical length of 2.5cm

Question 7

other than cervical length measuring, what is another screening test for preterm labor?

Answer 7

fetal fibronectin- if a negative test= good prognostic indication

Question 8

what are some risks for increased risk of preterm labor in the uterine stretch pathway

Answer 8

increased volume due to polyhydramnios, multiple gestations

Question 9

what MUST you have to diagnose preterm labor?

Answer 9

UTERINE CONTRACTIONS, and cervical change, dilation of 2 cm or greater and/or 80% effacement

Question 10

how do you manage preterm labor?

Answer 10

evaluate the cervix, and then reevaluate in an hour, hydrate during that hour, correct any correctable causes ( infection)

Question 11

what do you need to start with a preterm labor patient?

Answer 11

empiric penicillin treatment for group B strep, then culture and decide on course after results from culture

Question 12

what do you give to PTL patients to slow the onset of labor/stop it, if it was less than 34 weeks gestation?

Answer 12

magnesium sulfate, or nifedipine

Question 13

what is the dose of Mg sulfate you give for PTL?

Answer 13

6gram IV, then 3 gm /hour continuous

Question 14

what is the general mechanism of action of Mg sulfte and nifedipine?

Answer 14

they both work on calcium during AP

Question 15

what can you us in extremely premature babies, and can lead to premature closure of the ductus ateriousis?

Answer 15

protaglandin synthetase inhibitor- indomethicin

Question 16

what can you use as an adjuvant in PTL?

Answer 16

NSAIDS

Question 17

what is the lower limit of viability for a fetus in weeks and weight?

Answer 17

24 weeks, and 500 grams

Question 18

what is premature rupture of membranse?

Answer 18

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

Question 19

should you check the cervix of a presumed ruptured preterm patient?

Answer 19

NO- increses the risk of infection

Question 20

what are teh three tests you can use to confirm premature rupture of membranes?

Answer 20

pooling, nitrazine paper, ferning

Question 21

what do you call it when there is less than 5 cm of amniotic fluid index?

Answer 21

oligohydramnios

Question 22

what is the goal of treatment for preterm premature rupture of membranes?

Answer 22

continue pregnancy until lung profile is mature

Question 23

when will most premature rupture pts deliver?

Answer 23

34 weeks

Question 24

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

Answer 24

deliver the baby

Question 25

whater teh ACOG recomendations for PPROM pateints?

Answer 25

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

Question 26

how do you test for fetal lung maturity?

Answer 26

L/S ratio- greater than 2= mature
presence of prostaglandin = mature
greater than 46,000 lamellar bodies= mature

Question 27

what is intrauterine growth restriction?

Answer 27

birth weight of a newborn is below the 10% for a given gestational age

Question 28

what are some maternal causes of IUGR?

Answer 28

poor nutrition, ciggarette, drug abuse, asthma,

Question 29

what aer some placental causes of IUGR?

Answer 29

insufficient tansfer through the placenta–> HTN, renal disease, velamentous insertion of the cord

Question 30

what re some fetal causes of IUGR?

Answer 30

TORCH infections,

Question 31

is symetrical or asymmetrical IUGR more concerning?

Answer 31

asymmtrical, liver and pancreas undergo large changes in attempt to spare the brain

Question 32

how do you monitor for IUGR?

Answer 32

serial fundal height measurements

if fundal height lags more than 3 cm behind the gestational age, order an ultrasound

Question 33

what is the goal of managemnt of IUGR?

Answer 33

deliver before fetal compromise, but after lung maturity

Question 34

what do you use doppler study of umbilical artery for?

Answer 34

Dx of IUGR, if the diastolic flow is decreased on doppler in the uterine artery= IUGR

Question 35

is IUGR an indication for C section?

Answer 35

No, but teh fetus may not be able to handle delivery, so may get a C section anyway

Question 36

what is a postterm pregnancy?

Answer 36

if it goes past 42 weeks

Question 37

what type of babies tend to go past term?

Answer 37

anencaphaly, placental sulfatase deficiency, extra uterine pregnancy

Question 38

how do you managment of of post term ?

Answer 38

biweekly testing of baby in 41st week, if abnormal- induce labor, or induce labor at 42 weeks

Question 39

what do you suspect in a patient that comlains of absense of fetal movement or absense of fetal heart beat on ultrasound/

Answer 39

intrauterine fetal demise