[CLMD] Obstetric Complications [Wootton]

Question 1

What are some nonmodifiable risk factors for Preterm Labor (PTL)?

Answer 1

Socioeconomic Factors – African Americans

Medical and Obstetrical Factors:

Previous HIstory of PTL

History of 2nd trimester abortion

Repeated Spont 1st trimester abortion

bleeding in 1st trimester

UTI

Twins

Uterine Abnormalities

Polyhydraminos

Question 2

What are some modifiable risk factors of PTL?

Answer 2

Infection

Placental-Vascular

Pyschosocial Stress/Work Strain

Uterine Stretch

Question 3

What associations are we considering with Infection/Cervical pathway in terms of modifiable risk factors of PTL?

Answer 3

Bacterial Vaginosis

Tx for Group B Strep

Tx for Gonorrhea/Chlamydia

Question 4

In terms of cervical length how does it correlate with PTL?

Answer 4

As Cervical Length DECREASES; PTL INCREASES

Assess with Ultrasound, or Fetal Fibronectin (FFN)

Question 5

What are the 3 components to the Placental-Vascular Pathway?

Answer 5

Immunological Component

Vascular Component

Low Resistance connection of Spiral A

(Alteration of either of these, results in poor fetal growth –> PTL)

Question 6

What are the main hormones released in the Stress-Strain pathway that we can help to reduce?

Answer 6

Cortisol

Catecholamines

Question 7

Uterine Stretch pathway is a result of increasing volume, and is a risk factor in what 2 things?

Answer 7

Polyhydraminos

Multiple Gestations

Question 8

When & How do we diagnose PTL?

What symptoms are expected?

Answer 8

20-37 weeks w/ a CERVICAL EXAM, External Monitoring, FHR

Must have: Uterine Contractions, Cervical Dilation of 2cm (80% effacement)

Menstraul like cramping, Backache, Pelvic Pressure, Discharge (bloody), Uterine Contractions

Question 9

Once you have done the initial assessment, and before you can confirm PTL, how do you manage the patient?

Answer 9

Reevaluate Cervix after an hour

Oral/IV Hydration

Bed Rest

Cultures Taken –> for Group B Strep

Ultrasound

Question 10

Once you have DIAGNOSED PTL, how do you manage the patient?

Answer 10

Begin Tocolysis (MgSO4, Nifedipine, or Indomethacin)

also give Steroids if the baby is preterm (for Lung Growth)

Question 11

What is the benefit of giving MgSO4?

Answer 11

Neuroprotection, (against Cerebral Palsy)

(MgSO4 is given if less than 32 weeks)

Question 12

What are the benefits of giving Nifedipine for Tocolysis of a PTL patient?

Answer 12

Its an Oral agent

Minimal Maternal and Fetal Side affects

(replacing Mg as drug of choice)

Question 13

What are the benefits/risks of giving Indomethacyin (Prostaglandin Synthetase Inhibitors)?

Answer 13

Inhibits Prostaglandin –> induce myometrial contractions

Can be given ORAL or RECTAL

Can result in Oligohydraminios

Can cause premature closure of Fetal DA –> Pul HTN –> HF

Necrotizing Enterocolitis, Intracranial Hemorrhage

Question 14

What drug is not used for primary tx of preterm labor, but is shown to decrease uterine activity?

Answer 14

NSAIDS

Question 15

When do you give Glucocorticoids (Betamethasone)?

Answer 15

For Fetal Lung Maturation

(given between 24-34 weeks) – lasts 7 days

Question 16

What are the Risk Factors for PROM?

Answer 16

History of PROM

Vaginal/Cervical Infections

2nd/3rd trimester bleeding

Short Cervix

Low BMI

Low SES

smoking

Nutritional def

Question 17

How do you diagnose PROM?

Answer 17

Loss of FLuid

Confirmation of Amniotic Fluid in Vagina

Check for Rupture using Sterile Speculum

(don’t check cervix of PPROM –> increases risk of infection)

Question 18

How do you confirm PROM?

Answer 18

Pooling

Nitrazine Paper (turns blue)

Ferning

(US to evaluate amniotic fluid vol)

Question 19

What is the Expectant management of PPROM?

Answer 19

Continue pregnancy until lung profile is mature (Check Gestational Age)

Deliver at 34 weeks

Antiobiotic course (Ampicillin, Erythromycin/Azithro)

Tocolytic

Steroids

Amniotic Fluid Index

Fetal/Maternal Status

Question 20

In the case of PPROM, an intact amniotic sac prevents?

Answer 20

Chorioamnionitis

Question 21

What is Intrauterine Growth Restriction (IUGR)?

Answer 21

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

Question 22

What are Growth Restricted fetuses at a higher risk for?

Answer 22

Meconium Aspiration

Hypoxia

Stillbirth

Polycethemia

Hypoglycemia

Cognitive Delay

Adult onset HTN. Diabetes, CAD, Stroke

Question 23

How do we detect a fetus who is at risk of IUGR?

Answer 23

Physical Exam – Serial Fundal Heigth (primary screening tool)

US

Direct Studies – Amniocentesis, PUBS

Doppler Studies

Question 24

What are placental causes of IUGR?

Answer 24

HTN

Renal Dz

Placental/Cord Abnorm

Preexsiting Diabetes

Question 25

What are Fetal causes of IUGR?

Answer 25

Infections (TORCH, Listerosis) Congenital Anomalies Multiple Gestations Chrom Abnorm

Question 26

What are maternal causes of IUGR?

Answer 26

Bad Nutrtion Smoking Drug Abuse Alcoholism Cyanotic Heart Dz Pulmonary Insuff Antiphospholipid Synd Hereditary Thrombophilias Collagen Vascular Dz/Autoimmune Dz

Question 27

Why do we use US for diagnosis of IUGR?

Answer 27

To get a weight of the baby

Question 28

How do we manage IUGR, Pre-pregnancy? Antepartum?

Answer 28

Controlling Diabetes, HTN -------------------------------------------------- Deliver BEFORE fetal compromise Decrease modifying factors stop smoking improve nutrtion bed rest MONITOR patient

Question 29

What are some of techniques of Fetal Surveilance?

Answer 29

NonStress Testing (NST) Biophysical Profile (BPP) Doppler Study of Umbilical A

Question 30

is IUGR an indication for C-Section?

Answer 30

NO!

Question 31

What is the definition of a post-term pregnancy?

Answer 31

\>42 weeks | (normal is 38-42 weeks)

Question 32

If the baby is kept over 42 weeks, and isnt affected by palcental insufficiency what are they at a risk for?

Answer 32

Macrosomia (greater than 4500 grams) Abnormal Labor Shoulder Dystocia C-Section

Question 33

What causes a Post-Term Pregnancy?

Answer 33

Unsure Dates Fetal Adrenal Hypoplasia Anencephalic Fetuses Placental Sulfatase Def Extra-Uterine Preg

Question 34

What would you do at the 41st week of a suspected Post-Term Preg? 42nd week?

Answer 34

Begin Antenatal testing: **twice weekly NST and BPP** ## Footnote **Induce labor if abnormal!!** **--------------------------------------** **INDUCE LABOR!**

Question 35

What is Intrauterine Fetal Demise (IUFD)? Causes?

Answer 35

Fetal Death after 20 weeks gestation, but before onset of labor UNKNOWN -- lots of associated causes

Question 36

If a baby is kept post-term are they at a greater risk?

Answer 36

**YES**, they have a greater risk of **Perinatal mortality,** and **Postmaturity Syndrome** (loss of subq fat, long fingernails, dry and peeling skin, abundant hair)