18: Obstetrical Complications

Question 1

Preterm birth

Answer 1

Occurs after 20 weeks but before 37 weeks gestation; in labor, must have uterine contractions and cervical change (dilation of 2 cm and/or 80% effaced)

Question 2

Considerations for preventing infection

Answer 2

Treat BV, gonorrhea, chlamydia as all are known to increase risk of PTL; treat women in preterm labor with abx

Question 3

Fetal fibronectin

Answer 3

Released in response to disruption of membranes with uterine activity, cervical shortening or infections - suggests increased risk of delivery in 2 weeks

Question 4

Cortisol and catecholamines

Answer 4

Released in response to stress; can cause uterine contraction and assist labor (premature)

Question 5

When should you begin tocolysis during PTL?

Answer 5

Less than 34 weeks gestation with no contraindications and no response to IV hydration/rest

Question 6

Magnesium sulfate

Answer 6

Tocolytic drug of choice; therapeutic levels 5.5-7.0; 6 gm IV then 3 gm/hr continuous; neuroprotection and prevention of cerebral palsy; given at 32 weeks or less; lots of nasty side effects

Question 7

Nifedipine

Answer 7

Oral agent for suppressing PTL; minimal side effedts

Question 8

Indomethicin

Answer 8

Short term basis for tocolysis; given orally or rectally

Question 9

NSAIDS

Answer 9

Decrease contractions but not for primary treatment of preterm labor