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OB/GYN > Labor > Flashcards

Labor Flashcards

1
Q

What order should misoprostol and oxytocyin be done with unfavorable cervix?

A

Misoprostol first, then oxytocin

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2
Q

What are negative factors for successful TOLAC (trial of labor after cesarian delivery)?

A

Advanced maternal age, advanced gestational age, high BMI, high birth weight, shorter interval <19 mo between pregnancies

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3
Q

What timeframe indicates prolonged latent phase of labor?

A

Nulliparous: >20 h
Multiparas: >14 h

Treat with rest or augmentation of labor
Do NOT AROM due to increased risk of infection

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4
Q

What should be done for patient with secondary arrest of dilation (no further cervical change in active phase >4 h)

A

Amniotomy, followed by oxytocin after further evaluation

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5
Q

If patient is completely dilated and has been pushing, what are indications for cesarian delivery?

A

Macrosomia, fetopelvic disproportion

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6
Q

Which mentum position indicates C/S?

A

Persistent mentum posterior (head extended, facing posteriorly)

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7
Q

What is indicated by head emerging, then retracting (turtle sign)?

A

Shoulder dystocia - try McRoberts position (flexing legs up against hips and abducting hips to raise pubic symphysis)

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8
Q

What timeframe is previable birth?

A

20-26 weeks - you would want a NICU

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9
Q

What should you give if Group B Strep status is unknown and preterm labor has started?

A

Ampicillin, until culture result is negative or labor stops

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10
Q

What antibiotics should be given iso PPROM?

A

Ampicillin + erythromycin at <34 wga: delays latency period by 5-7 days while also reducing incidence of maternal chorioamnitis and neonatal sepsis

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11
Q

What antibiotics are indicated if chorioamnionitis is suspected?

A

Clindamycin and gentamicin

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12
Q

Is C-section indicated iso chorioamnionitis?

A

No - delivery is warranted through induction of labor

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13
Q

Which tocolytics are contraindicated for whom?

A

Mg sulfate contraindicated in myasthenia gravis
Indomethacin contraindicated at 33 weeks due to premature ductus arteriosus closure through inhibition of prostaglandin E2 synthesis
Ritodrine contraindicated in diabetic patients

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14
Q

What should be offered to singleton gestation with prior spontaneous preterm birth to reduce risk?

A

Progesterone supplementation starting at 16-24 wga

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15
Q

What are benefits of betamethasone treatment from 24-34 wga who are at risk of preterm delivery in 7 days?

A

Increase pulmonary maturity
Decrease incidence/severity of respiratory distress syndrome
Decrease incidence of intracerebral hemorrhage
Decrease incidence of necrotizing enterocolitis

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16
Q

What is benefit of fetal fibronectin test?

A

Used in women with symptoms of preterm labor from 24-35 wga and during routine screening from 22-30 wga

It has a NPV 99.2%, so negative test means patient will not deliver in next 7 days

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17
Q

Risk factors for placental abruption

A

Polyhydramnios –> rapid decompression of intrauterine cavity

18
Q

Risk factors for morbidly adherent placenta (e.g. placenta accreta)

A

Multiple prior C/S, preventing proper implantation
Low anterior placenta

19
Q

What is vasa previa?

A

When unprotected umbilical cord runs over the cervix due to insertion into the membranes

20
Q

What test is the antibody screen?

A

Indirect Coombs test

21
Q

What is indicated by abrupt onset of bleeding upon amniotomy along with fetal taachycardia, decels, and bradycardia?

A

Vasa previa

Also risk of bleeding during normal active labor

22
Q

What risks does smoking increase for pregnancy?

A

Placental abruption
Placental previa
Fetal growth restriction
Infection

23
Q

Why can cervicitis cause bleeding during pregnancy?

A

STIs result in inflammation in a more vascular cervix, resulting in bleeding

24
Q

Variable decels are associated with cord compression, which is associated with what amniotic fluid status?

A

Oligohydramnios

25
Q

When is tocolysis indicated in PPROM?

A

Prolong delivery long enough (48h) for steroids to obtain max benefit for fetal lung maturity

26
Q

What increases risk of fetal asphyxia?

A

Placental abruption
Difficult breech delivery
Maternal sedation

27
Q

PPROM before 24 wga results in what to the fetus?

A

Pulmonary hypoplasia; survival with PPROM between 20-23 wga is 25%

Deformation type structural abnormalities may be found

28
Q

What medication reduces risk of premature labor from all causes, including PPROM?

A

17 alpha-hydroxyprogesterone - administer weekly starting at16-20 wga and until 36 wga

29
Q

When is Mg sulfate given for PPROM?

A

<32 wga, for neuroprotection

30
Q

When are steroids given for PPROM?

A

Between 24-34 wga

31
Q

What can cause false positive nitrazine test?

A

Nitrazine test is based off amniotic fluid pH 7.1-7.3 > vaginal secretion pH of 4.5-6.0 - this can be thrown off by semen or blood

Use ferning and amniotic fluid index to confirm

32
Q

In whom are prostaglandins contraindicated?

A

Previous C/S - increased risk of uterine rupture

33
Q

How does maternal narcotic analgesia affect fetal heart rate tracing?

A

Decreased variability

34
Q

Amnioinfusion may be used for ________ type of decelerations?

A

Repetitive variable decelerations, NOT recurrent late decelerations

35
Q

What is fetal tachycardia associated with?

A

Maternal fever; chorioamnionitis

36
Q

What are initial measures for fetal hypoperfusion presenting with late decelerations, before deciding to do C/S?

A

Intrauterine resuscitation:
Left lateral positioning (increases perfusion to uterus)
Supplemental O2
Treat hypotension
Discontinue oxytocin
Tocolytics
IV fluids

37
Q

In preterm labor, what medications are given at what time points?

A

<32 weeks: Magnesium sulfate for fetal neuroprotection and indomethacin for tocolysis (not >32 wks due to premature closure of ductus arteriosus)
<37 weeks: Betamethasone to prevent neonatal respiratory distress syndrome

38
Q

For patients without prior spontaneous preterm birth, what should be done in 2nd trimester? What if they did?

A

Without: transvaginal US for cervical length; vaginal progesterone if <=2.5 cm at <24 weeks
With: If they had painful contractions, then IM/vaginal progesterone; if not, it was cervical insufficiency and cerclage should be performed

39
Q

Uterine tachysystole is managed how?

A

Lateral positioning; tocolysis; stopping oxytocin

40
Q

What order of antibiotics are used for GBS?

A

Penicillin or ampicillin (if allergic, then cefazolin)
Clindamycin (preferred over erythromycin)
Vancomycin - doesn’t reach amniotic fluid bactericidal concentration as rapidly so still need to watch baby

41
Q

Epidural insertion into vasculature causes what?

A

CNS hyperactivity from inhibition of inhibitory neurons:
Perioral numbness, metallic taste, tinnitus
Seizure
Sympathetic activation (HTN, tachycardia) leading to cardiovascular collapse

Treat seizure with benzo

OB/GYN (29 decks)

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