Abnormal Labor Flashcards
(35 cards)
-Tocolytic at < 32 weeks =
-Tocolytic at 32-34 weeks =
- indomethacin
- nifedipine
What is the recommended management for patients with PPROM at < 34 weeks gestation and signs of infection/fetal compromise?
- Antibiotics
- Corticosteroids
- Magnesium (if <32 weeks)
- Delivery
How do you manage preterm premature rupture of membrane (PPROM)?
- < 24 weeks:
- 24-34 weeks:
- ≥ 34 weeks:
- Abortion
- Steroids and antibiotics
- Expectant management and induction of labor can be considered
What is the recommended management for patients with PPROM at < 34 weeks gestation and NO signs of infection/fetal compromise?
Antibiotics, corticosteroids, and expectant management
Patients in preterm labor at ________ should receive magnesium sulfate for fetal neuroprotection
< 32 weeks
Next step in a patient with a total BPP score ≤ 4 points at ≥ 32 weeks of gestation
Induction of labor with oxytocin if there are no contraindications to vaginal birth.
A premature child has decreased tone, seizures, and rapidly increasing head circumference with bulging anterior fontanelle. What is the most likely diagnosis?
Intraventricular hemorrhage
The incidence of neonatal intraventricular hemorrhage may be reduced by preventing preterm labor and administering:
antenatal maternal corticosteroids
What hematologic pathology is characterized by normocytic anemia with a low reticulocyte count in preterm infants?
Anemia of prematurity
Prolonged second stage of labor (arrest of fetal descent) is defined as insufficient fetal descent after pushing for how long without an epidural?
- Nulliparous:
- Multiparous:
- > 3 hours
- > 2 hours
When is operative vaginal delivery (e.g. vacuum, forceps) indicated during the second-stage of labor? (3)
- Prolonged 2nd stage of labor
- Fetal distress (heart rate abnormalities)
- Maternal exhaustion
What are the four complications of PPROM?
- Umbilical cord prolapse
- Placental abruption
- Intraamniotic infection
- Preterm labor
Ultrasonography shows a complete breech presentation. During labor, this patient is at increased risk for which complication?
Umbilical cord prolapse
What is the most common cause of second stage arrest of labor?
Cephalopelvic disproportion, secondary to fetal malposition (e.g. occiput transverse)
The most common risk factor for PROM/PPROM is
ascending infection (esp. BV)
The second stage of labor is from _________until_________
complete dilation (10 cm)
delivery of the fetus
How is progression of the second stage of labor evaluated?
Fetal station
Patients who present in preterm labor at ≥34 weeks with breech presentation are managed with:
cesarean delivery
What is the next step in management for a healthy pregnant patient at 37 weeks gestation that desires a vaginal delivery? Ultrasound reveals the fetus is in a frank breech presentation. .
External cephalic version
- Early deceleration:
- Variable deceleration:
- Late deceleration:
- Head compression
- Umbilical cord compression
- Uteroplacental insufficiency and fetal hypoxemia
What is the first-line intervention for a woman in the first stage of labor with recurrent variable decelerations and moderate variability on fetal heart tracing?
Maternal repositioning and intravenous fluid administration
If maternal repositioning is unsuccessful, what are the subsequent intrauterine resuscitation measures that can be taken?
- Amnioinfusion
- Tocolytics (if tachysystole present)
- An emergency cesarean delivery is indicated if fetal heart tracings do not improve.
What are the prophylactic antibiotics given to a woman with PPROM?
IV erythromycin/azithromycin and IV ampicillin
What is the likely diagnosis in a laboring patient with ≥ 6 cm dilation that experiences no further dilation for 4 hours despite adequate contractions?
Arrested active phase of labor
