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z OB > ptl & prom > Flashcards

ptl & prom Flashcards

1
Q

preterm labor is…

A

labor occurring -> 20 to 37 - 1 cm (+ progressive!)- effacement 80% or morecontractions are regular, painful and:- 4 per 20 min OR - every 10 minutes OR - less for at least 30 minutesrisk factors often unknown; assess for/screen = VITAL

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2
Q

late preterm birth

A

34 - 36 weeks gestation

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3
Q

moderately preterm birth

A

32 - 34 weeks gestation

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4
Q

very preterm birth

A

prior to 32 completed weeks gestation

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5
Q

extreme preterm birth

A

at or less than 25 weeks gestation

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6
Q

low birth weight

A

=

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7
Q

moderately low birth weight

A

= 1500 to 2499 g (3.3 to 5.5lb)

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8
Q

very low birth weight

A

=

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9
Q

respiratory distress syndrome

A
  • not enough surfactant cells due to immaturity- decreased pulmonary gas exchange, leading to retention of carbon dioxide (increased arterial PCO2). Most common neonatal causes:- prematurity- perinatal asphyxia- maternal diabetes mellitus- hyaline membrane disease (HMD)
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10
Q

intraventricular hemmorhage

A

blood vessels of infant so fragile, any venous pressure can lead to bleed

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11
Q

bronchopulmonary dysplasia

A

iatrogenic; trauma caused by mechanical ventilation,

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12
Q

necrotizing enterocolitis

A

etiology/process unknown!- blood shunted from gut could be caused by overgrowth of bacteria before natural flora established- possible tube feeding formula = substrate for bacterial growth- perforation of gut

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13
Q

hyperbilirubinemia

A

?

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14
Q

intrauterine growth restriction (IUGR)

A

?

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15
Q

fetal compromise

A

?

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16
Q

intrauterine fetal demise (IUFD)

A

?

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17
Q

medically indicated preterm birth is…

A

…indicated for maternal or fetal reasons including: preeclampsia, diabetes, placenta previa, abruptio placenta, IUGR, fetal compromise, IUFD…accounts for 25% of preterm births

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18
Q

PTL: demographic risk factors

A

…maternal age = 35…highest incidence in non-hispanic black women…low SES, unmarried, low education level

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19
Q

PTL: behavioral/lifestyle risk factors

A

smoking, alcohol/substance abuse, DV, lack of social support, stress, physically demanding work conditions

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20
Q

PTL: medical risk factors

A

…infection/inflammation (only causality known FOR SURE)chorioamnionitis, UTI, genital tract, periodontal…autoimmune disorders…thromboembolic disorders…renal, cardiovascular diseasemom may be physically incapable of carrying baby…anemia

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21
Q

PTL: obstetrical/reproductive risk factors*

A
  • previous preterm birth* multifetal pregnancy* cervical, uterine abnormalities- short interval between pregnancies- PROM- abruption- vaginal bleeding- anemia- fetal anomalies
22
Q

PTL: common symptoms

A
  • often subtle, intermittent- may be present up to 2 weeks before hospital admit- persistent, low, dull backache- vaginal spotting- pelvic pressure- abdominal tightening, cramping- increased vaginal discharge- uterine contactions (q10” for 30” or less = CALL PROVIDER)
23
Q

PTL: definitive diagnosis

A

persistent uterine contractions AND documented cervical changeOReffacement >= 80% (subjective)ORdilation > 1 cm

24
Q

fetal fibronectin

A
  • glycoprotein produced by chorion found at junction of chorion (fetal membrane) and decidua (uterus)- better predictor of who WILL NOT go into PTL; negative = PTL very unlikely
25
Q

chorioamnionitis

A

?

26
Q

PTL: treatment

A

…no specific, standardized plan of care…patient education, bed rest, IV fluids, tocolytics/corticosteroids

27
Q

PTL: management

A

initial assessment/observation- change in dilation (recheck, same provider preferred)- monitor contractions- electronic fetal HR monitor- US

28
Q

PTL: tocolytic agents

A

beta mimetic adrenergic agents are US GOLD STANDARD: - ritodrine (only FDA approved tocolytic, but removed from market after PE documented post-use)- terbutalinealso- magnesium sulfate- indomethacin- nifedipineprimary goal of administration: get steroids in!

29
Q

PTL: corticosteroids

A

stimulate fetal lung maturation by inducing production/release of surfactant; single course recommended between 24 and 34 weeks- betamethasone, dexamethasone- optimal benefit 24 hours after first injection

30
Q

PTL: antibiotics

A

penicillin; prophylaxis for Group B Strepinfection is preterm baby’s worst enemy

31
Q

PTL: progesterone

A
  • weekly administration starting at 16 to 20 weeks- for women with previous PTL hx- reduces risk as much as 33%- exact MOA unknown
32
Q

3 interventions proven to reduce perinatal morbidity & mortality

A
  • transport of women to facility with NICU- administration of glucocorticoids- treatment with antibiotics for gbs
33
Q

cervical cerclage (why & what)

A
  • for cervical insufficiency
34
Q

cervical insufficiency

A

aka incompetence; dilation and shortening fo cervix prior to 37 weeks in the absence of contractions- typically painless- responsible for 20% of late 2nd trimester loss

35
Q

prophylactic cerclage (when)

A

12 to 14 weeks

36
Q

rescue cerclage

A

when cervical changes already detected

37
Q

premature rupture of membranes (prom)

A

rupture of fetal membranes with release of amniotic fluid more than one hour prior to onset of labor - 50% will go into labor within 24 hours

38
Q

preterm prom (pprom)

A

prom before 37 weeks- 1/3rd of preterm births

39
Q

prolonged prom

A

?

40
Q

pulmonary hypoplasia

A

?

41
Q

pprom assessment: fern

A

?

42
Q

pprom assessment: pool

A

?

43
Q

pprom assessment: nitrazine

A

?

44
Q

pprom assessment: ideal

A

93% accuracy with combo fern/pool/nitrazine

45
Q

pprom assessment: infection

A

maternal tachycardia, uterine tenderness, fever, foul smelling fluid

46
Q

nst

A

non-stress test?

47
Q

bpp

A

biophysical profile?

48
Q

pprom tx: labor inhibition

A
  • prolong pregnancy, no benefit to neonatal outcome- can be used in pts
49
Q

pprom tx: corticosteroids

A

betamethasonedexamethasone

50
Q

expectant management

A

?

51
Q

conservative management

A

?

z OB (10 decks)

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