6 - Complications of Labor and Delivery

Question 1

Preterm Delivery in weeks

Answer 1

Infants born before 37 weeks.

Question 2

Low-birth-weight infants (LBW)

Answer 2

> 2500g

Question 3

Intrauterine growth restriction (IUGR)/SGA

Answer 3

Infants who have not grown appropriately for their gestational age

Question 4

Risk factors for pre-term-labor (PTL)

Answer 4

Preterm rupture of membranes, chorioamnionitis, multiple gestations, uterine anomalies, previous preterm delivery, low maternal pregnancy weight (

Question 5

Common tocolytics

Answer 5

Hydration 1st (dehydrated patients have increased ADH that is similar to oxytocin and also synthesized in the hypothalamus, ADH can bind to oxytocin receptors and stimulate contractions).

Beta2 agonists (Ritodrine, terbutaline, salbutamol), Ca2+ channel blockers (nifedipine), NSAIDs (Prostaglandin inhibitors - Indomethacin, sulindac) Magnesium sulfate (Calcium antagonist and a membrane stabilizer - Myastenia G is an absolute contraindication),

Question 6

Reason to use tocolytics

Answer 6

Tocolytics prolong gestation for ~48hrs. This allows for treatment with steroids to enhance fetal lung maturity and reduce risks associated with preterm delivery.

Question 7

Betamethasone use in preterm labor

Answer 7

A glucocorticoid used to promote fetal lung development and shown to reduce the incidence of RDS and other complications of pre-term delivery.

Question 8

Assessing for Magnesium toxicity

Answer 8

Serial DTR exams. DTRs are depressed at [Mg]

Question 9

Preterm rupture of membranes

Answer 9

ROM occurring before week 37

Question 10

Premature rupture of membranes

Answer 10

ROM occurring before the onset of labor.

Question 11

Prolonged rupture of membranes

Answer 11

Anytime ROM occurs longer than 18hrs before delivery

Question 12

Management of Preterm ROM (PROM).

Answer 12

Depends on the gestational age of the fetus. 34 weeks - usually delivery

Question 13

Biggest concern for PROM

Answer 13

Chorioamionitis - risk increases with length of ROM.

Question 14

3 “Ps” of vaginal delivery

Answer 14

Passenger, pelvis, and power

Question 15

Cephalopelvic disproportion (CPD)

Answer 15

Most common cause of failure to progress (FTP) in labor

Question 16

Breech Presentation

Answer 16

Ass first. 3 typres - Frank (feet near head, extended knees), complete (one or both knees flexed), incomplete/footling (one foot/knee outside of birth canal).
Dx: Leopold maneuvers and US
Tx: external cephalic version, C-section, trial of vaginal breech delivery (not usually done - worse outcomes)

Question 17

Fetal position that maximizes probability of fetal head passing through birth canal.

Answer 17

OA (ROA or LOA can complete internal rotation to OA)

Question 18

Prolonged deceleration

Answer 18

FHR

Question 19

Fetal bradycardia

Answer 19

FHR

Question 20

Treatment of FHR decelerations

Answer 20

1 - move mom into L or R lateral decubitus position to relieve compression on IVC or fetal blood vessels.
2 - Oxygen facemask to mom
3 - Search for and address the underlying cause/pathology

Question 21

Fetal macrosomia

Answer 21

weight over 4000g

Question 22

First line treatment for pregnant women with seizures

Answer 22

IV or IM magnesium sulfate. Followed by ativan, then phenytoin, then phenobarbital