To Memorize for Module 2 quiz Flashcards
What are the types of Placenta Previa
Complete
Partial
Marginal
low lying
What are the risk factors for placenta previa
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
Risk factors for placenta abruption
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
How many grades of placenta abruption
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
Vasa Previa
when the vessels within the umbilical cord lie across the cervical os
Preterm Birth
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
Early preterm
< 34 weeks
Late preterm
34 0/7 - 36 6/ 7
Preterm labor and birth risk factors
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.
Sx of preterm labor
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
Signs of Preterm labor
short cervix
change in cervical effacement or dilation
Positive fetal fibronectin test
Ruptured membrane
What amount of cervical dilation may indicate that preterm labor is occurring
greater than 3 centimeters
What is the primary reason corticosteroids are used in PTL
assist in lung maturity…most beneficial intervention to improve neonatal outcome
When is corticosteroids recommended
-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.
What corticosteroids are used
Betamethasone
–Two 12 mg doses given IM 24 hours apart
Dexamethasone
— Four 6-mg every 12 hours IM
Function of Tocolytics
Temporarily cease contractions (48 hrs) long enough to allow corticosteroids to work
Common Tocolytics agents
Terbutaline (short term use due to maternal side effects
Calcium Channel Blockers (Nifedipine
NSAIDS (Indomethacin)
Upper limit of use 34 weeks
What is the primary benefit of Magnesium sulfate
Fetal neural protection
Recommended prior to 32 weeks gestation…. Ie cerebral palsy
Can also be used as tocolytic
When is Vaginal progesterone used
Short cervix identified with transvaginal ultrasound …prevention of preterm labor
Criteria for vaginal progesterone
Singleton gestation (No twins, etc etc)
No prior spontaneous preterm birth
Cervical length is 20 mm or less before or at 24 weeks gestation
What is the recommendation if patient had prior preterm birth and receiving progesterone supplementation since 16 weeks gestation
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
what should the cervical length be for vaginal progesterone
20 mm or less
What week pregnancy can vaginal progesterone be given
less than 24 weeks
Gold standard for testing for PPROM
Sterile speculum exam w/ferning and nitrazine
What gestation considered early term
37 0/7 - 38 6/7 weeks
What gestation considered full term
39 0/7 - 40 6/7 weeks
What gestation considered late term
41 0/7 - 41 6/7 weeks
what gestation considered postterm
42 0/7 and beyond weeks
what gestation considered late preterm
34 -36 6/7 weeks
Preterm ranges
Extremely preterm: 23-27 6/7
Very preterm:28- 31 6/7
Mod preterm: 32-33 6/7
Late preterm: 34-36 6/7
Very preterm
28 - 31 6/7
Extremely preterm
23 - 27 6/7
How does Nitrazine work
measures pH:
amniotic fluid alkaline pH 7.1-7.3
Vaginal fluid acidic pH 4.5-6.0
what is the sensitivity for nitrazine
87%
90%-97%
What is Nitrazine specificity
81%
16-70%
What causes false positive of Nitrazine
Antiseptics, Lubricants
BV, Trich
Blood
Urine
Semen
What causes false negatives of Nitrazine
Prolonged ROM or high leak with minimal fluid
What are the various tests for PPROM
Nitrazine
Fern
Vaginal pool
Amnisure
ROM plus
How does Fern work
Microscopically viewed:
Amniotic fluid high salt content caused a crystal pattern when dried
What is the sensitivity of Fern
51.4%
98%
What is the specificity of Fern
70.8%
88.2%
What causes false positive for Fern
Cervical mucus
Semen
What causes false negative for Fern
Excess blood
Not enough drying time
Thick specimen
When do you use Fetal Fibronectin (fFN)
22-23.6 weeks only
is fFN qualitative or quantitative result
Qualitative result more accurate if combined with cervical length
Accuracy for fFN for predicting No labor for the next 2 weeks
99% accurate for next 7 days
95% accurate for the following week
90% accurate for 3rd week after test
