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

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2
Q

PTL- etiology

A
  • spontaneous
  • mult gestations
  • PPROM
  • HTN
  • cervical incompetence or uterine anomalies
  • antepartum hemorrhage
  • IUGR (intrauterine growth restriction)
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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
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4
Q

prevention of PTL

A
  • infection (Cervical)
  • placental-vascular
  • psychosocial stress and work strain
  • uterine stretch
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5
Q

Infection pathway

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

- tx cervical infections

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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)
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7
Q

Placental-vascular pathway

A

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

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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
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9
Q

Uterine Stretch Pathway

A
  • uterine stretch as a result of inc volume

- risk factor in- polyhydramnios, mult gestations-

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10
Q

dx of PTL

A
  • 20-37 wks
  • must have:
  • uterine contractions
  • cervical change: cervical dilation of 2 cm and/or 80% effacement
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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
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12
Q

PTL- management- 2

A
  • hydration and bed rest- resolve contractions in 20%
  • cultures for Group B Strep
  • abx given empirically
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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)
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14
Q

Magnesium Sulfate

A
  • competes with calcium
  • continue tx until received both doses of steroids
  • role in neuroprotection- prevent against cerebral palsy
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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
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16
Q

Nifedipine

A
  • oral!

- minimal maternal and fetal SE’s

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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
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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
false + and neg nitrazine results
positive: -urine, semen, cervical mucus, blood, vaginitis neg: -remote PROM with no remaining fluid, minimal leakage
26
PPROM (preterm premature rupture of membranes)- management
- risk of infection and risk of preterm delivery- must be balanced - maternal risks- endomyometritis, sepsis, failed induction
27
PPROM- management depends on?
- gestational age at time of rupture- < 24 wks = pulm hypoplasia - amniotic fluid index- < 5 cm = oligohydramnios - fetal status - maternal status
28
PPROM- management
- 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
tests for fetal lung maturity
- lecithin, PI, PG- important for fetal lung maturity - measure these substances by amniocentesis - L/S ratio > 2= mature (lecithin-spingomyelin) - PG present = mature
30
other tests for fetal lung maturity
-LBND (lamellar body number density assessment)
31
IUGR (intrauterine growth restriction)
-birth weight of a newborn is below the 10% for a given gestational age
32
growth restricted fetuses- at risk for
- meconium aspiration - asphyxia - polycythemia - hypoglycemia - mental retardation - adult onset conditions
33
maternal causes of IUGR
- poor nutritional intake - cig smoking - drug abuse - alcoholism - cyanotic HD - pulm insuff - antiphospholipid syndrome
34
placental causes of IUGR
- insuff substrate transfer thru placenta and defective trophoblast invasion - HTN, renal dz, placental or crd abnormalities, diabetes
35
fetal causes of IUGR
- intrauterine infections - congenital anomalies/genetic disorders - mult gestations - chromosomal abnormalities
36
IUGR dx
- 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
IUGR- management
- 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
Nonstress testing
-fetal HR accelerates at least 15 beats /min above baseline
39
doppler study of umbilical a
- assess vascular impedance | - with IUGR- diminution of umbilical a diastolic flow
40
post-term pregnancy
- past 42 wks - postmaturity syndrome (in 20%)- aging and infarction of placenta- loss of subcutaneous fat, long fingernails, dry and peeling skin
41
post-term pregnancy- etiology
- unsure dates - fetal adrenal hypoplasia - anencephaly - placental sulfatase def - extra-uterine pregnancy
42
IUFD (intrauterine fetal demise)
- fetal death after 20 wks gestation but before onset of labor - most cases etiology is unknown (50%)
43
IUFD- dx
- 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
IUFD- management
- spontaneous labor will occur within 2-3 wks of fetal demise - induction of labor - monitor coagulopathy- at risk for DIC