labor & delivery complications + PP care (14%)

Question 1

3 categories of dystocia

Answer 1

power (uterine ctx)
passenger (presentation/size of fetus)
passage (uterus/soft tissue abnormalities)

Question 2

tx for shoulder dystocia

Answer 2

non-manipulative- 1st line- McRoberts (hip hyper flexion to inc pelvic opening)
manipulative- 2nd line- woods “corkscrew” (180 degree shoulder rotation)
c/s last resort

Question 3

complications of shoulder deistic

Answer 3

erb’s palsy (brachial plexus injury)

esp in macrosomic, multiparity, gestational DM

Question 4

what is the definition of PROM

Answer 4

water breaks <37wks

Question 5

RFs for PROM

Answer 5

STIs
smoking
prior preterm delivery
multiple gestations

Question 6

dx of PROM

Answer 6

sterile speculum exam- pooling of secretions
nitrazine paper test- blue if pH >6.5 (likely PROM)
fern test- crystallized estrogen + Fluid
US- AVOID DIGITAL EXAM

Question 7

normal vaginal vs amniotic fluid pH

Answer 7

vaginal- 3.8-4.2

amniotic fluid- 7-7.3

Question 8

tx of PROM

Answer 8

wait for spontaneous labor
monitor for chorio or endometritis
terbutaline/mag sulf to delay labor

Question 9

definition of premature labor

Answer 9

regular uterine ctx + progressive cervical changes <37wks

Question 10

what is the MC cause of perinatal mortality

Answer 10

premature labor

Question 11

when is a pt definitely in PTL

Answer 11

dilated 3+cm

effaced 80%+

Question 12

when is a pt likely in PTL

Answer 12

dilated 2-3cm

effaced <80%

Question 13

when is a pt unlikely in PTL

Answer 13

dilated 2cm or less

effaced <80%

Question 14

when should steroids be given to mom in PTL

Answer 14

if L:S ratio <2:1 or <34wk GA

betamethasone

Question 15

when should tocolytics be used in PRL

Answer 15

if no chorio is present (no infxn)

give for 48h to delay until steroids work

Question 16

what tocolytics can you give in PTL

Answer 16

indomethacin
nifedipine
mag sulfate
terbutaline (beta2 agonist)

Question 17

rules w mag sulfate use in PTL

Answer 17

(MUST ADMIT IF ADMINISTERED, don’t use w nifedipine)

Question 18

ADR of terbutaline

Answer 18

maternal pulmonary edema

Question 19

what abx should be given in PTL

Answer 19

GBS ppx:
ampicillin followed by PO amox + azithro

OR

cefazolin followed by PO keflex + azithro if PCN allergy

Question 20

contraindications for induction of labor

Answer 20

prior uterine rupture or C/S
active genital herpes infxn
umbilical cord prolapse
placenta previa or vasa previa
transverse fetal lie

Question 21

types of induction

Answer 21

early- women w unfavorable cervix to promote ripening (cervidil, balloon cath, laminar, miso)

later- when cervix is <1cm dilated w some effacement (IV oxytocin, monitor uterine activity + fetal HR)

amniotomy- cervix partially dilated + there is effacement; use small hook to rupture membranes

Question 22

what is the definition of PP hemorrhage

Answer 22

> 500ml blood loss in vaginal birth

>1000ml blood loss in c-section

Question 23

MC etiology of PP hemorrhage

Answer 23

uterine atony

others: uterine rupture, congestion, DIC, bleeding disorders

Question 24

presentation of PP hemorrhage

Answer 24

hypovolemic shock- hypotension, tachycardic, pale/clammy skin, dec cap refill
uterine atony- soft, boggy uterus w dilated cervix

Question 25

tx of postpartum hemorrhage

Answer 25

``` bimanual uterine massage tx underlying cause IV access uterotionic agents (oxytocin, methylergonovine, IM carboprost, tromethamine, misoprostol) to inc ctx (only if uterus is soft + boggy) suction + curettage if products retained ```

Question 26

early vs delayed PP hemorrhage

Answer 26

early- 24hr | delayed 24hr-8wks

Question 27

what is the presentation of endometritis

Answer 27

``` fever >!00.4 tachycardia abd pain uterine tenderness +/- vaginal bleeding/dc, foul odor ```

Question 28

when does endometritis usu occur

Answer 28

2-3 days PP

Question 29

tx of endometritis

Answer 29

post c/s- clinda + genta +/- amp post vag or chorioamnionitis- amp + gent

Question 30

biggest RF for endometritis

Answer 30

c-section

Question 31

ppx for endometritis

Answer 31

if c-section, give 1st gen cephalosporin during surgery

Question 32

describe postpartum blues

Answer 32

starts 2-4days PP, resolves w/i 10 days NO THOUGHTS OF HARMING BABY no tx, self-limited

Question 33

describe postpartum depression

Answer 33

starts 2wks-2mo PP, lasts 3-14mo +/- THOUGHTS OF HARMING BABY +/- antidepressant tx