Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

R2F > Obstrectical Complications > Flashcards

Obstrectical Complications Flashcards

1
Q

Preterm Labor

A
  • b/w 20 and 37 wks

- uterine contractions with cervical change or dilation of 2 cm and/or 80% effaced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PTL- etiology

A
  • spontaneous
  • mult gestations
  • PPROM
  • HTN
  • cervical incompetence or uterine anomalies
  • antepartum hemorrhage
  • IUGR (intrauterine growth restriction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PTL- risk factors

A
  • prev hx of PTL
  • hx of second trimester abortion
  • spontaneous 1st trimester abortions
  • bleeding in 1st trimester
  • UTI
  • mult gestation
  • uterine anomalies
  • polyhydramnios
  • incompetent cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

prevention of PTL

A
  • infection (Cervical)
  • placental-vascular
  • psychosocial stress and work strain
  • uterine stretch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infection pathway

A
  • bacterial vaginosis- tx of women in preterm labor with abx

- tx cervical infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cervix and PTL

A
  • risk of PTL inc as cervical length dec!!! (RR 6.2 for 2.5 cm)
  • US- to screen- check cervical length
  • fetal fibronectin (FFN)- released in response to disruption of membranes (uterine activity, cervical shortening, infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Placental-vascular pathway

A

-immunologic, vascular components, low resistance connection of spiral a’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stress-Strain pathway

A
  • inc release of cortisol and catecholamines
  • cortisol- inc CRH- assist in labor
  • catecholamines- affect blood flow and can cause uterine contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Uterine Stretch Pathway

A
  • uterine stretch as a result of inc volume

- risk factor in- polyhydramnios, mult gestations-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dx of PTL

A
  • 20-37 wks
  • must have:
  • uterine contractions
  • cervical change: cervical dilation of 2 cm and/or 80% effacement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PTL- management

A
  • cervical exam- assess dilation, effacement
  • evaluate for underlying correctable problems (infection)
  • monitor uterine activity and fetal HR
  • oral or IV hydrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PTL- management- 2

A
  • hydration and bed rest- resolve contractions in 20%
  • cultures for Group B Strep
  • abx given empirically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

if no response to IV hydration and rest or dx 2 cm and/or 80% effaced- then begin?

A

tocolysis!!!

  • Magnesium Sulfate
  • Nifedipine
  • Indomethacin (prostaglandin syn inhibitor)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Magnesium Sulfate

A
  • competes with calcium
  • continue tx until received both doses of steroids
  • role in neuroprotection- prevent against cerebral palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Magnesium Sulfate- SE’s

A
  • maternal- warmth, flushing, N/V, resp depression, cardiac conduction defects
  • neonate- loss of m tone, drowsiness, lower Apgar scores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Nifedipine

A
  • oral!

- minimal maternal and fetal SE’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Prostaglandin Synthetase Inhibitors

A
  • inhibits prostaglandin prod (induce myometrial contractions)
  • used for extreme prematurity
  • Indomethacin- can result in oligohydramnios, premature closure of fetal ductus arteriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

NSAIDs (ibuprofen)

A
  • dec uterine activity
  • not used for primary tx of preterm labor
  • used when not met dx of preterm labor or after discontinuing magnesium
19
Q

Glucocorticoids- used for?

A

fetal lung maturation (in premature babies)

-given b/w 24-34 wks

20
Q

prevention of PTL- tx

A
  • progesterone- give from 16-36 wks- smooth m relaxant
  • vaginal progesterone- in women with shortened cervix
  • Arabin pessary
21
Q

PROM

A

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

22
Q

PROM- risk factors

A
  • vaginal/cervical infections
  • abnormal membranes
  • incompetent cervix
  • nutritional def
23
Q

PROM- dx

A
  • loss of fluid
  • confirmation of amniotic fluid in vagina
  • do not check the cervix of a presumed ruptured preterm pt!!!- inc risk of infection
24
Q

Confirmation of PROM

A
  • pooling
  • nitrazine paper (turns blue)
  • ferning
25
Q

false + and neg nitrazine results

A

positive:
-urine, semen, cervical mucus, blood, vaginitis
neg:
-remote PROM with no remaining fluid, minimal leakage

26
Q

PPROM (preterm premature rupture of membranes)- management

A
  • risk of infection and risk of preterm delivery- must be balanced
  • maternal risks- endomyometritis, sepsis, failed induction
27
Q

PPROM- management depends on?

A
  • gestational age at time of rupture- < 24 wks = pulm hypoplasia
  • amniotic fluid index- < 5 cm = oligohydramnios
  • fetal status
  • maternal status
28
Q

PPROM- management

A
  • continue pregnancy until lung profile is mature!!
  • most deliver at 34 wks!
  • must monitor for signs/sxs of chorioamnionitis- maternal T > 100.4, fetal or maternal tachycardia, tender uterus, foul smelling amniotic fluid/purulent discharge
  • abx!!!- ampicillin and erythromycin
29
Q

tests for fetal lung maturity

A
  • lecithin, PI, PG- important for fetal lung maturity
  • measure these substances by amniocentesis
  • L/S ratio > 2= mature (lecithin-spingomyelin)
  • PG present = mature
30
Q

other tests for fetal lung maturity

A

-LBND (lamellar body number density assessment)

31
Q

IUGR (intrauterine growth restriction)

A

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

32
Q

growth restricted fetuses- at risk for

A
  • meconium aspiration
  • asphyxia
  • polycythemia
  • hypoglycemia
  • mental retardation
  • adult onset conditions
33
Q

maternal causes of IUGR

A
  • poor nutritional intake
  • cig smoking
  • drug abuse
  • alcoholism
  • cyanotic HD
  • pulm insuff
  • antiphospholipid syndrome
34
Q

placental causes of IUGR

A
  • insuff substrate transfer thru placenta and defective trophoblast invasion
  • HTN, renal dz, placental or crd abnormalities, diabetes
35
Q

fetal causes of IUGR

A
  • intrauterine infections
  • congenital anomalies/genetic disorders
  • mult gestations
  • chromosomal abnormalities
36
Q

IUGR dx

A
  • fundal ht!!!
  • US- used for high risk conditions that predispose to IUGR (HTN, renal dz, diabetes, drug abuse, antiphospholipid syndrome)
  • amniocentesis
  • percutaneous umbilical blood sampling
37
Q

IUGR- management

A
  • optimize dz processes (diabetes, HTN)
  • dec any modifying factors (stop smoking, improve nutrition)
  • deliver b/f fetal compromise but after fetal lung maturity!!!
  • non stress test 2x/wk, biophysical profile, doppler studies of umbilical a
38
Q

Nonstress testing

A

-fetal HR accelerates at least 15 beats /min above baseline

39
Q

doppler study of umbilical a

A
  • assess vascular impedance

- with IUGR- diminution of umbilical a diastolic flow

40
Q

post-term pregnancy

A
  • past 42 wks
  • postmaturity syndrome (in 20%)- aging and infarction of placenta- loss of subcutaneous fat, long fingernails, dry and peeling skin
41
Q

post-term pregnancy- etiology

A
  • unsure dates
  • fetal adrenal hypoplasia
  • anencephaly
  • placental sulfatase def
  • extra-uterine pregnancy
42
Q

IUFD (intrauterine fetal demise)

A
  • fetal death after 20 wks gestation but before onset of labor
  • most cases etiology is unknown (50%)
43
Q

IUFD- dx

A
  • absence of fetal movements or if unable to Doppler fetal heart tones
  • confirm- US w/ lack of fetal activity and absence of fetal cardiac activity
44
Q

IUFD- management

A
  • spontaneous labor will occur within 2-3 wks of fetal demise
  • induction of labor
  • monitor coagulopathy- at risk for DIC

R2F (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions