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high risk OB > PTL, PPROM, chorio, multiple gestation > Flashcards

PTL, PPROM, chorio, multiple gestation Flashcards

1
Q

-gestation 20 to <37 weeks
-uterine cxs
-cervical changes

A

preterm labor

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2
Q

gestation 20 to <37 weeks
birth

A

preterm birth

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3
Q

3 categories of preterm

A

very preterm: <32.0
moderately preterm: 32.0-33.6
late preterm: 34.0-36.6

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4
Q

3 categories of term

A

early term: 37.0-38.6 weeks
full term: 39.0-40.6 weeks
late term: 41.0-41.6 weeks

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5
Q

what is considered low birth weight

A

<2500 grams at birth

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6
Q

*lowdermilk box 32-1 and 32-2

A
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7
Q

factors that may explain increase in preterm birth rates

A

-increase twins and multiples from IVF
-increased births to AMA moms
-increase medically induced prematurity
-early repeat C/S
-C/S w/o medical indications
-advances in MFM and NN care
-increase pregnancies in HR women
-increased fetal complications requiring early birth (ex : IUGR)

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8
Q

potential triggers of inflammation

A

-microbial invasion amniotic cavity
-maternal obesity
-uterine overdistention
-subclinical genital tract infections

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9
Q

stimuli from an inflammatory response causes a withdrawal of functional progesterone

A

inflammatory response

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10
Q

examples of pathways of interaction of factors

A

-inflammation
-maternal/fetal stress
-abnormal uterine distention
-bleeding/thrombophilia
-hormones/toxins

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11
Q

big 3 risk factors for PTB

A

-current multifetal pregnancy
-h/o PTB
-uterine/cervical abnormalities

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12
Q

medical condition risk factors for PTB

A

-DM
-HTN
-clotting disorders
-previous 2nd tri abortion
-inadequate nutritional status (underweight/obese, inadequate weight gain, anemia)
-infections
-abnormal lipid metabolism

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13
Q

demographic risk factors for PTB

A

-age (<17 or >35)
-AMA
-low socioeconomic status
-black race
-tobacco
-substance abuse
-maternal/fetal stress

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14
Q

behavioral/environmental risk factors for PTB

A

-substance abuse
-DES exposure
-maternal/fetal stress
-intimate partner violence
-lack of social support
-long working hours
-long periods standing
-exposure to environmental substances (pollution, radiation, lead, paint, smoke)

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15
Q

pregnancy associated risks for PTB

A

-late/no prenatal care
-vaginal bleeding (esp 2nd/3rd tris)
-PPROM
-short interpregnancy interval (<18 mos)
-changes maternal microbiome
-fetal anomalies

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16
Q

when would fetal fibronectin be found in vaginal fluid

A

disruption in chorion
good for predicting you won’t go into labor
fFN shouldn’t be in vaginal fluid normally between 24-34 EGA

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17
Q

what factors could affect the accuracy of the fFN test for PTL

A

-ROM
-sexual intercourse past 24 hrs
-cervical examination/vaginal ultrasound past 24 hrs
-vaginal bleeding
-infections (intraamniotic/vaginal)
-douche/vaginal lubricant use

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18
Q

two tests for PTL/PTB

A

fFN
PAMG-1

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19
Q

what is considered a short cervix

A

<25 mm @16-24 EGA

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20
Q

who might get a cervical cerclage

A

h/o PTB @17-33.6 EGA
cervical length <25 mm before 23 EGA
only best for singleton pregnancies

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21
Q

who might receive progesterone

A

h/o PTB
cervical length <20 mm @ <24 EGA
*started at 15-20 weeks until 36 weeks

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22
Q

meds that inhibit contractions

A

tocolytics

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23
Q

when can tocolytics be given

A

22-33.6 wks EGA

24
Q

4 tocolytic meds

A

-mag sulfate: CNS depressant, smooth muscle relaxant
-terbutaline/brethine: beta mimetic
-indocin: NSAID
-nifedipine (adalat, procardia): CCB

25
Q

general contraindications for tocolytic meds

A

-acute fetal compromise
-intraamniotic infection/chorio
-eclampsia/severe preeclampsia
-fetal demise
-fetal maturity
-placental abruption
-maternal bleeding with instability
-pulmonary HTN
-PPROM (except for steroid admin and transfer)

*basically anything that means birth is imminent

26
Q

contraindications to terbutaline

A

-tachycardia sensitive maternal cardiac disease
-poorly controlled maternal DM
-maternal hyperthyroidism
-maternal seizure disorders

27
Q

contraindications to mag sulfate

A

-maternal hypocalcemia
-maternal myasthenia gravis
-maternal renal failure

28
Q

contraindications to indomethacin

A

-gestation >32 weeks
-maternal asthma
-maternal coronary artery disease
-maternal GI bleeding
-platelet dysfunction/bleeding disorder
-oligohydramnios
-renal failure
-suspected fetal cardiac/renal anomaly
-maternal liver disease
-IUGR

29
Q

contraindications to nifedipine

A

-maternal CV disease
-maternal aortic insufficiency
-maternal hemodynamic instability
-maternal hypoTN
-no combo with beta mimetic drugs

30
Q

purpose of giving mag sulfate for PTL/PTB

A

decreased incidence cerebral palsy
NN neuroprotection

31
Q

purpose of giving betamethasone/dexamethasone for PTL/PTB

A

DECREASED INCIDENCE OF:
-RDS
-intraventricular hemorrhage
-NEC
-NN death

32
Q

S+S PTL pt teaching

A

-malaise/discomfort/fatigue
-uterine activity (Cxs q10mins, cramping like period)
-low dull backache
-suprapubic pain/pressure
-feeling baby is pushing down/balling up
-vaginal discharge (increased amount or change)
-urinary frequency

33
Q

pt teaching what to do if S+S PTL

A

-empty bladder
-lateral rest 1 hr
-palpate for ctx
-if continues/worsens call hcp or go to clinic

34
Q

when should woman go to clinic/birth facility immediately (S+S)

A

-ctx q10mins for 1 hr +
-vaginal bleeding
-fluid leaking from vagina
-odorous vaginal discharge

35
Q

spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at any EGA

A

premature rupture of membranes PROM

36
Q

membranes rupture before 37.0 weeks EGA

A

preterm premature rupture membranes PPROM

37
Q

PPROM risk factors

A

-low socioeconomic status
-poor nutritional status
-tobacco/substance abuse
-infection (including h/o STDs)
-incompetent cervix
-trauma

38
Q

Tx PPROM for >34 weeks EGA

A

delivery

39
Q

Tx PPROM for32-34 weeks EGA

A

assess fetal lung maturity
mature: deliver

40
Q

Tx PPROM for <32 weeks EGA

A

expectant management:
-fetal assessment
-monitor for complications
-abx 7 days
-glucocorticoids

41
Q

risk factors chorioamnionitis

A

-ROM
-maternal malnutrition, poverty, substance abuse
-repeated vaginal exams
-internal monitoring in labor
-vaginitis, cervicitis, previous cerclage

42
Q

Dx chorio

A

-maternal fever (>39 C once, >38 C twice, >38 + additional criteria)
-fetal tachy (>160)
-leukocytosis (>15k)
-purulent cervical drainage
-pos gram stain for bacteria

43
Q

S+S chorio

A

-maternal fever
-fetal tachy
-leukocytosis
-uterine pain and tenderness
-foul smelling vaginal discharge
-malaise
-maternal tachy
-uterine cxs

44
Q

management chorio

A

-IV hydration
-IV abx and oxytocin
-decrease maternal temp
-delivery

45
Q

possible NN complications from chorio

A

-sepsis/bacteremia
-pneumonia
-meningitis
-RDS
-cerebral palsy
-neurologic deficits

46
Q

maternal body adaptations to multi fetal pregnancy

A

-hyperemesis
-increased plasma volume (50-100% increase)
-dependent edema, increased risk pulmonary edema
-increased O2 consumption, increased pH
-increased SOB

47
Q

S+S of recipient twin in TTTS

A

-hypervolemia
-polycythemia
-polyhydramnios
-CHF
-death

48
Q

S+S of donor twin in TTTS

A

-hypovolemia
-anemia
-growth restricted
-oligohydramnios

49
Q

Dx of TTTS

A

-monochorionicity
-amniotic fluid discrepancy (poly and oligo)

50
Q

timing for delivery for dichorionic twins:
-uncomplicated
-isolated fetal growth restriction
-fetal growth restriction and coexisting condition (maternal or fetal)

A

uncomplicated: 38.0-38.6
isolated growth restriction: 36.0-37.6
growth restriction and coexisting condition: 32.0-34.6

51
Q

timing for delivery for monochorionic twins:
-MC/DA uncomplicated
-MC/DA w isolated fetal growth restriction
-MC/MA uncomplicated

A

-MC/DA uncomplicated: 34.0-37.6
-MC/DA w isolated fetal growth restriction: 32.0-34.6
-MC/MA uncomplicated: 32.0-34.0

52
Q

purpose of tocolytics and how long should they be administered

A

can delay preterm birth up to 48 hrs (but not prevent it)
dont admin for >48 hrs

53
Q

side effects mag

A

drowsiness
decreased RR
arrhythmias
bradycardia
hypoTN
diarrhea
muscle weakness
flushing
sweating
hypothermia

54
Q

side effects nifedipine

A

headache
arrhythmias
HF
peripheral edema
flushing
stevens-johnson syndrome

55
Q

main difference between testing fFN and PAMG-1 for PTB/PTL

A

-PAMG-1 testing is less affected by other factors (recent vaginal exam)
-PAMG-1 higher negative predictive value

high risk OB (14 decks)

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