more ob complications of pregnancy Flashcards
What is the definition of PROM?
rupture of the amniotic sac with spillage of amniotic fluid before the onset of labor
What are risk factors for PROM?
infection, cervical insufficiency, poor maternal nutrtion, prior PROM
What is the treatment of PROM?
What is the definition of preterm labor?
onset of labor before 37 wks gestation
How is preterm labor treated?
- before 34 wks: expectant management, hospitalization, hydration, tocolytics for 48 hrs (magnesium, terbutaline, indomethacin, nifedipine), steroids for 48 hrs, consider ampicillin to cover GBS
- after 34 wks, expectant management if lung maturity is proven. consider inducing delivery if reason to do so, ampicillin if needed. glucocorticoids and tocolytics have no benefit
What is placenta previa?
implantation of placenta on or near the cevical os. may be low (near the cervix), partial, or complete
don’t do manual or speculum exams in these cases- incr. risk of hemorrhage
What are risk factors for placenta previa?
multiparity, incr maternal age, prior placenta previa, prior c section, twins, uterine fibrois, hx of abortion, SMOKING
What are the most common causes of vaginal bleeding after 20 wks?
placenta previa and placental abruption. bleeding in placenta previa should be painless while bleeding in placental abruption is painful
What are the risk factors for placental abruption?
HTN, prior abruption, tobacco use, cocaine use, PROM, multiparity, multiple gestation
What are the complications of placental abruption?
DIC, severe hemorrhage, fetal demise in 20%; increased risk
What are risks to mom of multiple gestations?
HTN, DM, preeclampsia, preterm labor
How should multiple gestation pregnancies be managed?
assess fetal growth with ultrasound, weekly NSTs starting at 36 wks
