Complications of L&D Flashcards by jaclyn krupsky

leading cause of fetal m&m in US?

preterm delivery

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what is considered low birthweight?

< 2500g

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prematurity => increased risks of what?

Resp'y distress syndrome
hyaline mem dis
intraventricular hemorrhage
sepsis
NEC

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RFs for PTL:

PROM
chorioamnionitis
placental abruption
maternal low bw
previous PTL
low SES
multiple gestation
uterine anomalies
maternal preeclampsia, infection, dis

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what is the only FDA-approved tocolytic?

ritodrine

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most tocolytics prolong gestation by how much? Why does this help?

48h. Helps allow betamethasone tx for fetal lung maturity.

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ritodrine and terbutaline are what kind of drug? How do they work?

beta-agonists (bind to and activate B2 R’s => increased cAMP => sequestration of Ca2+ in SR, inh of MLCK)

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SEs of ritodrine & terbutaline?

HA
tachycardia
anxiety
rare pulmonary edema & death

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how does magnesium sulfate work?

is a calcium blocker & membrane stabilizer

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SEs of magnesium:

flushing
HA
fatigue
diplopia

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what is a toxic mag level? Signs of toxicity?

10mg/dL
resp'y depression
pulm edema
hypoxia
cardiac arrest
loss of DTRs

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what’s the best way to r/o mag tox?

serial reflex checks

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SE’s of nifedipine:

HA
flushing
dizziness

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how should tocolytics be dosed?

Loading dose then maintenance doses.

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how does indomethacin work?

blocks COX => decreases PG level

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indomethacin is ass’d w/what in fetus?

premature closure of ductus arteriosus
pulm HTN
oligohydramnios 2/2 renal failure

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what % of pg’ies end with PTD?

10%

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how long will it usually take for labor to start in a pt w/premature ROM?

24-48h without intervention

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what is the tampon test?

inject a dye into amniotic sac. Watch for it to come out vagina onto tampon. If it does, ROM has occurred.

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when is the risk of prematurity = to the risk of infection in a pt w/PPROM?

b/w 32 and 36 weeks.

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what med is indicated in PPROM and why?

ampicillin +/- erythromycin, b/c it prolongs the onset of labor

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how long are tocolytics usually admin’d after PPROM?

48h to admin a course of corticosteroids

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what is FTP?

Study These Flashcards

failure to progress in labor

what are the 4 shapes of maternal pelvis?

Study These Flashcards

gynecoid
android
anthropoid
platypelloid

what is the obstetric conjugate?

distance b/w sacral promontory and symphysis pubis (shortest AP diam of pelvic inlet)

what to do in a case of suspected cephalopelvic disproportion?

usually a trial of labor, unless u/s or CT have shown CPD

incidence of breech presentation?

3-4%

what are the 3 types of breech presentation?

complete - feet are near fetal head frank - knees are flexed, feet are near the breech, not at the head. incomplete/footling - foot is in vagina

what are the 3 mgt options for breech babies?

external version trial of vaginal delivery c/s

what are CI's to trial of vaginal delivery w/breech baby?

nulliparity incomplete breech fetal weight > 3800g

when can a vaginal delivery occur with face presentation?

with mentum anterior presentation (chin up)

why is a brow presentation considered a malpresentation?

b/c a larger diameter m/pass thru pelvis this way.

what is a compound presentation?

an extremity presenting alongside the vertex or breech

how to manage a compound presentation?

if its an upper extremity, try gently reducing it. | If its a leg, need c/s.

what do you need to suspect in all cases of compound presentation?

umb cord prolapse

what is a persistent occiput transverse position? Why tends to get this?

baby's head remains turned to one side, doesn't do internal rotation towards Occiput Anterior. Moms w/a platypelloid pelvis.

mgt of persistent OT?

manual rotation | forceps or vacuum

how to classify the etiologies of prolonged FHR decels?

pre-uterine utero-placental postplacental

what are some pre-uterine causes of prolonged FHR decels?

maternal PE, amniotic fluid embolus, MI, seizure, hypotension 2/2 epidural

what are some utero-placental causes of prolonged FHR decels?

abruption infarction previa uterine hyperstiml'n

what are some post-placental causes of prolonged FHR decels?

cord prolapse cord compression rupture of fetal bv

approach to finding the cause of FHR decels:

1) eval mom for signs of resp'y compromis or AMS 2. while putting on a glove for cervical exam, look at mom's HR and BP 3. look for increased vaginal bleeding 4. Perform a cervical exam. Abdominal hand should feel for uterine tetany, fetal parts outside uterus, fetal station higher than expected (suspects uterine rupture)

mgt of FHR decels:

turn mom onto her other side | give mom O2

what to do if maternal hypotension 2/2 epidural?

IV fluids, ephedrine

tx of tetanic uterine ctr'ns:

NTG | terbutaline

mgt of umb cord prolapse:

c/s, lifting fetal head off cord.

what is shoulder dystocia?

impaction of ant shoulder behind pubic symphysis

RF's for shoulder dystocia:

``` fetal macrosomia pre-gestational & gestational DM previous shoulder dystocia maternal ob postterm pg'y long 2nd stage operative vag delivery ```

if you anticipate a shoulder dystocia, how to prepare?

pt in dorsal lithotomy position | cut episiotomy

tx of shoulder dystocia:

1. McRoberts maneuver 2. suprapubic P 3. rubin maneuver 4. wood corkscrew maneuver 5. Deliver post arm/shoulder

what is McRoberts maneuver

sharp flexion of maternal hips to decrease inclination of pelvis

what is Rubin maneuver:

get your hand on one accessible shoulder and push it towards baby's chest. Decreases overall bisacromial diameter.

what is wood corkscrew maneuver?

apply P behind post shoulder to rotate infant & dislodge ant shoulder

what to do if maneuvers don't work to dislodge ant shoulder?

try them again. If still doesn't work, break clavicle.

what is zavanelli maneuver?

put infant's head back into pelvis, take to c/s.

how to diff'ate b/w seizure and vasovagal events?

seizure has a post-ictal state. Vasovagal events may be accompanied by tonic-clonic jerks, but no post-ictal state.

mgt of pg pt w/seizures:

1) ABCs 2) check FHR 3) give a bolus of MgSO4 4) lorazepam 5) phenytoin 6) if still seizing, try phenobarbital 7) get labs - electrolytes, AED levels, G, tox screen 8) if FHR continues t/b nonreassuring, emergent delivery.

Complications of L&D Flashcards

(57 cards)