Obstrectical Complications Flashcards
Preterm Labor
- b/w 20 and 37 wks
- uterine contractions with cervical change or dilation of 2 cm and/or 80% effaced
PTL- etiology
- spontaneous
- mult gestations
- PPROM
- HTN
- cervical incompetence or uterine anomalies
- antepartum hemorrhage
- IUGR (intrauterine growth restriction)
PTL- risk factors
- 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
prevention of PTL
- infection (Cervical)
- placental-vascular
- psychosocial stress and work strain
- uterine stretch
Infection pathway
- bacterial vaginosis- tx of women in preterm labor with abx
- tx cervical infections
Cervix and PTL
- 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)
Placental-vascular pathway
-immunologic, vascular components, low resistance connection of spiral a’s
Stress-Strain pathway
- inc release of cortisol and catecholamines
- cortisol- inc CRH- assist in labor
- catecholamines- affect blood flow and can cause uterine contractions
Uterine Stretch Pathway
- uterine stretch as a result of inc volume
- risk factor in- polyhydramnios, mult gestations-
dx of PTL
- 20-37 wks
- must have:
- uterine contractions
- cervical change: cervical dilation of 2 cm and/or 80% effacement
PTL- management
- cervical exam- assess dilation, effacement
- evaluate for underlying correctable problems (infection)
- monitor uterine activity and fetal HR
- oral or IV hydrate
PTL- management- 2
- hydration and bed rest- resolve contractions in 20%
- cultures for Group B Strep
- abx given empirically
if no response to IV hydration and rest or dx 2 cm and/or 80% effaced- then begin?
tocolysis!!!
- Magnesium Sulfate
- Nifedipine
- Indomethacin (prostaglandin syn inhibitor)
Magnesium Sulfate
- competes with calcium
- continue tx until received both doses of steroids
- role in neuroprotection- prevent against cerebral palsy
Magnesium Sulfate- SE’s
- maternal- warmth, flushing, N/V, resp depression, cardiac conduction defects
- neonate- loss of m tone, drowsiness, lower Apgar scores
Nifedipine
- oral!
- minimal maternal and fetal SE’s
Prostaglandin Synthetase Inhibitors
- inhibits prostaglandin prod (induce myometrial contractions)
- used for extreme prematurity
- Indomethacin- can result in oligohydramnios, premature closure of fetal ductus arteriosis
NSAIDs (ibuprofen)
- dec uterine activity
- not used for primary tx of preterm labor
- used when not met dx of preterm labor or after discontinuing magnesium
Glucocorticoids- used for?
fetal lung maturation (in premature babies)
-given b/w 24-34 wks
prevention of PTL- tx
- progesterone- give from 16-36 wks- smooth m relaxant
- vaginal progesterone- in women with shortened cervix
- Arabin pessary
PROM
-premature rupture of membranes before the onset of labor at any gestational age
PROM- risk factors
- vaginal/cervical infections
- abnormal membranes
- incompetent cervix
- nutritional def
PROM- dx
- loss of fluid
- confirmation of amniotic fluid in vagina
- do not check the cervix of a presumed ruptured preterm pt!!!- inc risk of infection
Confirmation of PROM
- pooling
- nitrazine paper (turns blue)
- ferning