Obstetrical Complications

Question 1

definition of preterm birth?

Answer 1

-occurs after 20 weeks but before 37 completed weeks of gestation

Question 2

what are the four main pathways that we use to prevent PTL?

Answer 2

• Infection
• placental-vascular
• psychosocial stress and work strain
• uterine stretch

Question 3

which abx do we treat women in preterm labor with?

Answer 3

-treat for group B strep

Question 4

relative risk for PTL increases as ______ decreases?

Answer 4

• cervical length

- use that and fetal fibronectin as screening tools

Question 5

diagnosis of PTL

Answer 5

• between 20 and 37 weeks gestation

- must have: 1.) uterine contractions, 2.) cervical change (dilation of 2 cm or 80% effacement)

Question 6

how do we initially manage PTL?

Answer 6

hydration and bed rest will resolve contractions in about 20 % of patients

• culture for Group B strep
• fetal ultrasound

Question 7

What do we do if there is no response to IV hydration and rest?

Answer 7

• begin tocolysis
• MgSO4
• Nifedipine
• PG synthetase inhibitors (indomethacin)

Question 8

What does MgSO4 do?

Answer 8

• competes with Ca2+ for entry into cell at time of depolarization
• IV

Question 9

NIfedipine

Answer 9

• Oral
• inhibits slow, inward current of calcium during second phase of the action potential
• suppresses PTL

Question 10

Prostaglandin synthetase inhibitors

Answer 10

• Pg’s usually induce myometrial contractions… so we stop it
• Indomethacin is used
• maybe oligohydramnios
• greater risk of necrotizing enterocolitis for infant

Question 11

what do we give to make the fetal lungs mature a little more?

Answer 11

• Betamethasone
• between 34 and 36 weeks at risk of preterm birth within 7 days
• have not received a previous course of antenatal corticosteroids

Question 12

What mechanical thing is used in women with a shortened cervix to help prevent PTL?

Answer 12

-Arabin pessary

Question 13

What is Premature rupture of membranes (PROM)?

Answer 13

-premature rupture of the membranes before the onset of labor at any gestational age

Question 14

PROM diagnosis

Answer 14

• based on history
• loss of fluid
• confirmation of amniotic fluid in vagina

Question 15

***What do we NOT do is we think there is a preterm infant in there with a presumed ruptrured membrane?

Answer 15

• Do NOT check the cervix
• it increases risk of infection especially with the prolonged latency before delivery
• rupture is confirmed using a sterile speculum

Question 16

what will we see if there is PROM?

Answer 16

• pooling
• nitrazine paper turns blue
• ferning

Question 17

What is PPROM?

Answer 17

-preterm premature rupture of membranes

Question 18

What is the main goal of PPROM management?

Answer 18

-to continue preggo until lung profile is mature

Question 19

What does ACOG recommend that we do for PPROM antibiotic usage?

Answer 19

-48 hour course of IV Ampicillin and Erythromycin/azithromycin followed by 5 days of Amoxil and Erythromycin

Question 20

How long do we want to keep the baby in there at lesat to reduce the risk of RDS?

Answer 20

-34 weeks

Question 21

What cells in the fetus produce surfactant?

Answer 21

-type 2 pneumocytes

Question 22

What do we want the L/S ratio to be for fetal lungs?

Answer 22

• greater that 2

- Lecithin/Sphingomyelin

Question 23

What means that the fetal lung is mature if it’s there?

Answer 23

-Phosphatyidyl glycerol (PG)

Question 24

What is the rapid test for fetal lung maturity?

Answer 24

-the Lamellar body number density assessment (LBND)

Question 25

definition of Intrauterine growth restriction (IUGR)?

Answer 25

-when the birth weight of a newborn is below the 10% for a given gestational age

Question 26

What are the 3 main categories of IUGR with regard to etiology?

Answer 26

• maternal
• placental
• fetal

Question 27

what are some maternal causes of IUGR?

Answer 27

• ciggs
• alcoholism
• Anti phospholipid syndrome

Question 28

Placental causes of IUGR?

Answer 28

• defective trophoblast invasion
• diabetes
• placental or cord abnormalities

Question 29

Fetal causes of IUGR?

Answer 29

• inadequate or altered substrate
• TORCH
• multiple gestations

Question 30

What is the main thing for IUGR diagnosis?

Answer 30

-Ultrasound

Question 31

What is used as a primary screening tool for IUGR?

Answer 31

-serial fundal height measurement

Question 32

When do we order an ultrasound for IUGR?

Answer 32

-if the fundal height lags more than 3 cm behind the gestational age

Question 33

What is the main goal in the management of IUGR?

Answer 33

-deliver before fetal compromis but after fetal lung maturity

Question 34

What is the key thing with doppler study of the umbilical artery?

Answer 34

• the Umbilical flow velocity waveform of normally growing feuses is characterized by high-velocity diastolic flow
• with IUGR, there is diminution of umbilical artery diastolic flow

Question 35

What should we do if we suspect an IUGR?

Answer 35

• do an ultrasound.. if normal, no intervention
• if >38-39 weeks, then deliver
• if less, begin antenatal testing
• if normal, continue pregnancy, if not, deliver

Question 36

What is the definition for post-term pregnancy?

Answer 36

-past 42 weeks
-perinatal mortality is higher
-

Question 37

What do we end up doing for management of postterm preggo?

Answer 37

-induce labor!

Question 38

definition of IUFD

Answer 38

-fetal death after 20 weeks gestation but before the onset of labor

Question 39

When do we suspect IUFD?

Answer 39

• if patient complains of absence of fetal movements or it unable to Doppler fetal heart tones
• confirm by ultrasound with lack of fetal activity and absence of fetal cardiac activity

Question 40

What are the patient with IUFD at risk of?

Answer 40

• DIC

- need CBC, fibrinogen level, PT/PTT/INR

Question 41

What do we do for follow up for the IUFD?

Answer 41

• search for cause: TORCH, listeria… etc

- the later preggos will have greater risk, so give them antenatal testing