health challenges in labour and birth Flashcards
(43 cards)
why is the rate of preterm births increasing?
- average age of mothers is older
- fertility treatment more common
- increasing role of infection
what are some factors that may contribute to preterm labour?
- inflammation
- race
- toxicology
- stress
- nutrition
- cervical surgery
- uterine distension
- genetics
- previous PTB
what is fetal fibronectin and why is it tested for?
- it is a glycoprotein released into cervical/vaginal fluid in response to inflammation or separation of amniotic membranes
- normally is present until 22 weeks and then not again until time of labour
- a negative test means it is 98% likely a pregnancy will continue at least 2 more weeks
- positive test between 24-34 weeks could indicate risk of preterm labour
- negative is a more definitive result than a positive
what are some strategies to avoid stimulation that could trigger or progress preterm labour?
- minimal or no vaginal exams as they can stimulate and increase risk of infection
- no sex
- no nipple stimulation
- keep bladder empty
some other interventions that may or may not be helpful vs the risk:
- bedrest
- IV hydration
- MgSO4
- Sedation
what do tocolytic drugs do?
they are medications that stop contractions
what are some common tocolytics used to slow or stop preterm labour?
- indomethacin (anti-prostaglandin)
- Nifedipine (calcium channel blocker)
- progesterone
how does indamethacin work as a tocolytic?
- it is an anti-prostaglandin and inhibits uterine activity
- effective short-term at delaying delivery 48 hours or so
- ideal for creating window to give corticosteroids or MgSO4 for health of fetus
what tocolytic is appropriate for long-term prevention of preterm labour?
progesterone
what is cervical insufficiency?
-when there is premature, painless dilation of the cervix without contraction between 20-28 weeks
why may corticosteroids be given during preterm labour?
-to decrease prenatal mortality, the risk of respiratory distress syndrome and intraventricular hemorrhage
what medications are given to “mature” the lungs of a preterm infant?
- corticosteroids
- usually betamethasone (12mg IM q24h x2) or dexamethasone (6mg IM q12hr x4)
why may MgSO4 be given during preterm labour?
- new evidence suggests that there is a neuroprotective effect
- women less than 37 weeks gestation could be given this once dilated to or greater than 4 cm
- given a 4g loading dose over 30 min and then 1g/hr until delivery
what are some possible causes of bleeding during pregnancy?
- spontaneous abortion
- ectopic pregnancy
- gestational trophoblastic disease
- placenta previa
- abruption placentae
- uterine rupture
what criteria defines spontaneous abortion?
- occurs naturally
- expulsion of fetus before 20 weeks gestation or expulsion of a fetus weighing less than 500 g
what are some interventions that may be done if a spontaneous abortion occurs?
- give a drug to contract uterus (cytotec, RU486, cervidil)
- give winrho if mom is rH -ve to prevent development of antibodies
- IV therapy or blood transfusion if needed
- dilation and curettage if needed
- dilation and suction evacuation if needed
- providing physical and emotional support
what is an ectopic pregnancy?
-when a fertilized ovum implants outside of the uterus
95% of ectopic pregnancy end up in the fallopian tube, but are risks and symptoms associated with this?
- sharp unilateral pain
- decreased BP
- syncope
- referred shoulder pain, lower abdominal pain
- vaginal bleeding
- rupture of tube if interventions not done before then
what is gestational trophoblastic disease?
- a rare condition where abnormal development of the placenta occurs
- trophoblastic cells obliterate the pregnancy
- sometimes called molar pregnancy
- can develop into choriocarcinoma
what are signs of gestational trophoblastic disease?
- classic signs of pregnancy, but exaggerated, excellerated, and exacerbated
- uterine enlargement greater than gestational age
- vaginal bleeding and passage of clots
- hyperemesis gravidum
- development of hypertension before 24 weeks
what is an antepartum hemorrhage?
- vaginal bleeding that occurs after 20 weeks gestation
- 2 main causes are placenta previa and abruptio placentae
- can also have uterine or cervical causes
what is the blood flow to the uterus and placenta?
700-1000 mL/min
what is the major maternal risk if the vascular integrity of uterus/placenta is disrupted during late pregnancy?
-exsanguination within 8-10 minutes
how common is placenta previa?
4/1000 births
how common is abruptio placentae?
1/100 births
