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WH707 > To Memorize for Module 2 quiz > Flashcards

To Memorize for Module 2 quiz Flashcards

1
Q

What are the types of Placenta Previa

A

Complete
Partial
Marginal
low lying

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2
Q

What are the risk factors for placenta previa

A

Hx of placenta previa
hx of c-section
hx of vitro fertilizaation for infertility
smokes
cocaine use
multiparity
surgery on reproductive organs…etc myomectomy, etc
Advanced maternal age
prior suction and curretage

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3
Q

Risk factors for placenta abruption

A

A. Health history…including behaviors
* smoking
* Cocaine use
* Maternal age over 35
* HTN
* Hx of placenta abruption
B. Specific to current pregnancy
* preeclampsia
* Sudden uterine decompression
* Short umbilical cord
C. Unexpected trauma
* motor vehicle accident
* Fall
* blow to abdomen

Uterine factors
* Leiomyoma
* Prior cesarean birth

Rapid uterine decompression
* Multiple gestation
* Polyhydramnios

Maternal disease
* Thrombophilia
* Hypothyroidism
* Asthma

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4
Q

How many grades of placenta abruption

A

3
Grade 1: Small amount of vaginal bleeding and some uterine contraction
No signs of fetal distress or low blood pressure
Grade 2: Mild to medium amount of bleeding and uterine contraction.
The baby’s heart rate may show signs of distress
Grade 3: Medium to severe or hidden bleeding:
Also uterine contractions that don’t relax
Belly pain
Low blood pressure
Death of baby

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5
Q

Vasa Previa

A

when the vessels within the umbilical cord lie across the cervical os

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6
Q

Preterm Birth

A

Birth occurring between 20 0/7 and 36 6/7 weeks following:
PTL (Preterm labor)
PPROM (Preterm Prelabor rupture of membrane
Cervical insufficiency
Medical or obstetrical indication

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7
Q

Early preterm

A

< 34 weeks

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8
Q

Late preterm

A

34 0/7 - 36 6/ 7

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9
Q

Preterm labor and birth risk factors

A

Mechanical:
- Multiple gestaton
- Polyhydramnios
- Cervical abnormalities (short cervix)
-Placenta Abruption

Medical
- HTN
- DM
- PPROM
- Clotting disorder
- Being over or underweight
- Having vaginal bleeding
- fetal defects
- short interpregnancy interval less than 18 months

Infection/Inflammation
- Urogenital infections: bacterial vaginosis/STI
- Intraamniotic infection
- UTI

Despite the multitude of potential risk factors the majority of women giving birth preterm have no identifiable risk factors.

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10
Q

Sx of preterm labor

A

abdominal tightness or menstrual like cramps
diarrhea
fetus dropping low into the pelvis before 36 weeks
increased vaginal discharge (clear, pink, or slightly blood mucus)
Lower back pain
Pelvic pressure
Vaginal bleeding
Uterine contractions that are increasing in frequency, duration and intensity

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11
Q

Signs of Preterm labor

A

short cervix
change in cervical effacement or dilation
Positive fetal fibronectin test
Ruptured membrane

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12
Q

What amount of cervical dilation may indicate that preterm labor is occurring

A

greater than 3 centimeters

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13
Q

What is the primary reason corticosteroids are used in PTL

A

assist in lung maturity…most beneficial intervention to improve neonatal outcome

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14
Q

When is corticosteroids recommended

A

-A single course between 24-34 weeks of gestation for patient at risk of delivery within 7 days

Also decrease newborn respiratory morbidity when given between 34 0/7 weeks to 36 6/7 weeks to those at risk of preterm delivery within 7 days and have not previously received corticosteroids.

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15
Q

What corticosteroids are used

A

Betamethasone
–Two 12 mg doses given IM 24 hours apart
Dexamethasone
— Four 6-mg every 12 hours IM

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16
Q

Function of Tocolytics

A

Temporarily cease contractions (48 hrs) long enough to allow corticosteroids to work

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17
Q

Common Tocolytics agents

A

Terbutaline (short term use due to maternal side effects
Calcium Channel Blockers (Nifedipine
NSAIDS (Indomethacin)

Upper limit of use 34 weeks

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18
Q

What is the primary benefit of Magnesium sulfate

A

Fetal neural protection
Recommended prior to 32 weeks gestation…. Ie cerebral palsy
Can also be used as tocolytic

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19
Q

When is Vaginal progesterone used

A

Short cervix identified with transvaginal ultrasound …prevention of preterm labor

20
Q

Criteria for vaginal progesterone

A

Singleton gestation (No twins, etc etc)
No prior spontaneous preterm birth
Cervical length is 20 mm or less before or at 24 weeks gestation

21
Q

What is the recommendation if patient had prior preterm birth and receiving progesterone supplementation since 16 weeks gestation

A

Cerclage should be considered if cervical length is less then 25 mm before 24 weeks of gestation and….
Prior preterm birth occurred at less then 34 weeks gestation

22
Q

what should the cervical length be for vaginal progesterone

A

20 mm or less

23
Q

What week pregnancy can vaginal progesterone be given

A

less than 24 weeks

24
Q

Gold standard for testing for PPROM

A

Sterile speculum exam w/ferning and nitrazine

25
Q

What gestation considered early term

A

37 0/7 - 38 6/7 weeks

26
Q

What gestation considered full term

A

39 0/7 - 40 6/7 weeks

27
Q

What gestation considered late term

A

41 0/7 - 41 6/7 weeks

28
Q

what gestation considered postterm

A

42 0/7 and beyond weeks

29
Q

what gestation considered late preterm

A

34 -36 6/7 weeks

30
Q

Preterm ranges

A

Extremely preterm: 23-27 6/7
Very preterm:28- 31 6/7
Mod preterm: 32-33 6/7
Late preterm: 34-36 6/7

31
Q

Very preterm

A

28 - 31 6/7

32
Q

Extremely preterm

A

23 - 27 6/7

33
Q

How does Nitrazine work

A

measures pH:
amniotic fluid alkaline pH 7.1-7.3
Vaginal fluid acidic pH 4.5-6.0

34
Q

what is the sensitivity for nitrazine

A

87%

90%-97%

35
Q

What is Nitrazine specificity

A

81%
16-70%

36
Q

What causes false positive of Nitrazine

A

Antiseptics, Lubricants
BV, Trich
Blood
Urine
Semen

37
Q

What causes false negatives of Nitrazine

A

Prolonged ROM or high leak with minimal fluid

38
Q

What are the various tests for PPROM

A

Nitrazine
Fern
Vaginal pool
Amnisure
ROM plus

39
Q

How does Fern work

A

Microscopically viewed:
Amniotic fluid high salt content caused a crystal pattern when dried

40
Q

What is the sensitivity of Fern

A

51.4%

98%

41
Q

What is the specificity of Fern

A

70.8%
88.2%

42
Q

What causes false positive for Fern

A

Cervical mucus
Semen

43
Q

What causes false negative for Fern

A

Excess blood
Not enough drying time
Thick specimen

44
Q

When do you use Fetal Fibronectin (fFN)

A

22-23.6 weeks only

45
Q

is fFN qualitative or quantitative result

A

Qualitative result more accurate if combined with cervical length

46
Q

Accuracy for fFN for predicting No labor for the next 2 weeks

A

99% accurate for next 7 days
95% accurate for the following week
90% accurate for 3rd week after test

WH707 (24 decks)

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