Class 2 Complications of Labor

Question 1

What is “Term”?

Answer 1

Single pregnancy 37-42 completed weeks

Question 2

Preterm labor definition.

Answer 2

Regular contractions at least every 10 minutes resulting in cervical change prior to 37 weeks.

Question 3

Low birth weight (LBW)

Answer 3

infant < 2500g

Question 4

Very low birth weight (VLBW)

Answer 4

Infant < 1500g

Question 5

Infant mortality for < 24 weeks, < 30 weeks, >34 weeks?

Answer 5

• 90% death
• 90% survival
• 98% survival

Question 6

Survival can increase ___% each day between weeks __ - ___.

Answer 6

• 5%

- 25 - 26

Question 7

8 Premature comorbidities.

Answer 7

• intercranial hemorrhage
• Ischemic cerebral damage
• Immature metabolism
• Hypoglycemia
• Hyperbilirubin
• Necrotizing enterocolitis
• respiratory distress
• Sepsis

Question 8

When is premature respiratory distress seen? And what exacerbates the symptoms?

Answer 8

• All infants < 27 weeks 0% by 36 weeks

- Intrapartum hypoxia and maternal stress

Question 9

What 3 bacteria causes preterm labor?

Answer 9

• Group B Strep
• Gonorrhea
• Bacterial vaginosis

Question 10

When is C-section safer than vaginal delivery for PTL?

Answer 10

Breech

Question 11

How does an epidural help in PTL?

Answer 11

• Avoids precipitous delivery
• Decrease risk of ICH
• Avoids maternal pushing against incomplete cervix

Question 12

What are tocolytics?

Answer 12

• Drugs used to stop or slow contractions

- Used between 20-34 weeks and <2500 g

Question 13

Are tocolytics used for long term or short term use and why?

Answer 13

• Short term

- Allow time for steroids to aid in lung maturation or transfer to a NICU

Question 14

How doe ethanol work as a tocolytic?

Answer 14

• Inhibits release of ADH and Oxytocin
• Direct effect on myometrium
• Interference with prostaglandins

Question 15

3 risks of ethanol?

Answer 15

• Intoxication
• LOC
• Aspiration

Question 16

How does methylxanthines work as tocolytics and what is the side effect?

Answer 16

• Phosphodiesterases increase cAMP and cause uterine muscle relaxation
• Narrow therapeutic margin

Question 17

How do calcium channel blockers work as tocolytic?

Answer 17

-Decrease free calcium = decreased contractility

Question 18

Name a calcium channel blocker tocolytic.

Answer 18

-Nifedipine

Question 19

2 major problems with calcium channel blockers?

Answer 19

• More prone to cardiac depressant effect of volatile agents

- Increased risk of post partum hemorrhage due to uterine atony

Question 20

2 examples of prostaglandin synthetase inhibitors used as tocolytics. and how does it work?

Answer 20

• indomethacin and Sulindac

- Decrease cyclooxygenase = decreased prostaglandins

Question 21

Maternal side effects of Prostaglandin Synthetase Inhibitors.

Answer 21

• nausea
• Heartburn
• Platelet aggregation
• Pulm HTN

Question 22

Fetal side effects of Prostaglandin Synthetase Inhibitors.

Answer 22

• Crosses placenta
• closure of ductusarterosis
• Fetal circulation
• renal impairment

Question 23

What is the most common tocolytic used and how does it work?

Answer 23

• Magnesium

- Competes with calcium for uterine smooth muscle binding which decreases contractility

Question 24

A patient on Mag is more sensitive to what type of drugs?

Answer 24

-Both depolarizing and non-depolarizing muscle relaxants

Question 25

A patient on MAG has a ________ MAC for inhalational agents.

Answer 25

-Decreased

Question 26

What is the normal treatment range for MAG?

Answer 26

-4-7mg

Question 27

What happens at MAG levels of 8-10? 10-15? 20+

Answer 27

- Loss of DTR - Resp depression, Wide QRS, ↑ P-R - Cardiac arrest

Question 28

Beta adrenergic agonist tocolytic therapy meds.

Answer 28

- Terbutaline | - Ritodrine

Question 29

Major problem with Beta adrenergic agonists.

Answer 29

-Beta agonist pulmonary edema

Question 30

Beta agonist pulmonary edema risk factors.

Answer 30

- IV fluids - Multiple gestation - Tocolysis > 24hrs - MAG therapy - Infection - Hypokalemia - Heart disease

Question 31

Why is mortality of 2nd twin increased?

Answer 31

- Placental abruption - Cord prolapse - Malpresentation

Question 32

Maternal consequences of multiple gestation.

Answer 32

- Increased CO - Anemia - ↓ TLC, FRC - increased Closing capacity - Increased O2 Consumption - Increased metabolic rate - Increased aspiration risk

Question 33

What may be required for internal manipulation, and what drug is used?

Answer 33

- Uterine relaxation | - Nitroglycerine

Question 34

Signs of uterine rupture.

Answer 34

- Abdominal pain - Vag bleeding - Hypotension - Cessasition of labor - Fetal distress (most reliable)

Question 35

Presentation with Greatest chance of uncomplicated birth?

Answer 35

- Vertex - Flexed C-spine - Occiput anterior

Question 36

What is External cephalic version?

Answer 36

-Manipulation of fetus through the abdominal wall.

Question 37

What is post maturity?

Answer 37

-Gestation beyond 42 weeks

Question 38

Complications of post-maturity

Answer 38

- Decreased uterine blood flow - Cord compression - Meconium staining of amniotic fluid - Macrosomia

Question 39

Most common cause of intrauterine fetal demise.

Answer 39

-Cord accidents

Question 40

If there is prolonged retention of fetus ______ may become a concern.

Answer 40

DIC

Question 41

Describe prolapsed umbilical cord.

Answer 41

- Cord presents through cervix and is compressed by baby | - 10 minutes before fetal demise

Question 42

What is Monoamniotic twins? and what is the associated risk?

Answer 42

- Share single placenta and amniotic sack | - Cord entanglement

Question 43

Risk of cords 72cm

Answer 43

- Compression, constriction and rupture | - Entanglement

Question 44

What is a nuchal cord?

Answer 44

Cord around neck

Question 45

What is umbilical cord torsion?

Answer 45

twisting of cord around itself