Lecture 1 - Complications of Labor

Question 1

How many weeks pregnancy does “Term” refer to?

Answer 1

37-42 wks

Question 2

What does Preterm labor mean?

Answer 2

regular contractions occurring at least every 10min resulting in cervical change prior to 37 wks.

Question 3

Under what weight is condsidered Low Birth Weight (LBW)?

Answer 3

Any infant < 2500g at birth

Question 4

Under what weight is considered Very Low Birth Wt (VLBW)?

Answer 4

< 1500g

**At 29 wks gestation, >90% of expected fetal weight is < 1500g

Question 5

What is the survival rate for infants born at:
< 24wks?
>30wks?
>34wks?

Answer 5

24 wks ~10%
30 wks >90%
34 wks > 98%

Question 6

Survival of an infant can increase by _____% each day between 25-26 wks

Answer 6

5% per day

Question 7

__________ __________ __________ will affect almost all infants < 27wks gestational age.

Answer 7

Resp Distress Syndrome

Question 8

Besides resp distress syndrome, what are some other problems that affect premature infants?

Answer 8

sepsis, Nec enterocolitis, Intracranial hemorrhage, Ischemic cerebral damage, immature metabolism (prolong Rx effects), hypoglycemia, hyperbilirubinemia

Question 9

What are some causes of preterm Labor?

Answer 9

Group B strep
Neisseria Gonorrhea
Bacterial Vaginosis
***antibiotics can prevent preterm labor with some success

Question 10

Will having a preterm baby delivered C-section prevent intracranial hemorrhage?

Answer 10

No

Question 11

Will use of forceps for vaginal delivery increase the chances of intracranial hemorrhage in a preterm infant?

Answer 11

No

Question 12

For a preterm infant that is breech, what delivery method is prefered, C-section or vaginal birth?

Answer 12

C-section

Question 13

What can an epidural help prevent in PTL?

Answer 13

Avoid preciptous delivery
Decrease risk of ICH
Avoid maternal pushing agains an incomplete cervix

Question 14

What are some indications for Tocolytic Therapy?

Answer 14

Gestation age 20-34 wks
EFW < 2500g
Absence of fetal distress

Question 15

Does Tocolytic therapy reduce morbidity if used long-term?

Answer 15

No, but it does permit corticosteroid treatment to aid fetal lung development if used for 48hrs or less or allow for transfer to a facility with a NICU.

Question 16

Tocolytic therapy - problem with using Ethanol?

Answer 16

causes intoxication, LOC, aspiration

**no longer used because there’s better drugs out there

Question 17

Tocolytic therapy - problem using methylxanthines (aminophylline, phosphodiesterase)?

Answer 17

Narrow therapeutic margin and frequent toxic side effects

Question 18

Tocolytic therapy - Calcium channel blockers - side effects?

Answer 18

Hypotension, tachycardia, dizzy, palpitation
facial flushing
vasodilation, peripheral edema
Myocardial depression, conduction defects
Hepatic dysfunction
Postpartum hemorrhage
Fetal side effects
Decreased UBF –> fetal hypoxemia and fetal acidosis

Question 19

Calcium channel blockers - major concern?

Answer 19

pt more prone to cardiac depressant effects of volatile agents
- increase risk of postpartum hemorrhage due to uterine atony refractory to oxytocin and prostaglandin F-a2

Question 20

Tocolytic therapy - how does Indomethacin or Sulindac effect labor?

Answer 20

decreases cyclooxygenase –> decrease prostaglandin

Question 21

Maternal side effects of indomethacin or sulindac?

Answer 21

Nausea
Heartburn
Transient dec. platelet aggregation –> bleeding
Primary pulmonary HTN

Question 22

What are some side effects to the fetus from using indomethacin or sulindac?

Answer 22

Crosses placenta
Premature closure of ductusarteriosus
Persistent fetal circulation
Renal impairment, transient oliguria

Question 23

Tocolytic Therapy - using Magnesium will have what affect on muscle relaxants? MAC?

Answer 23

Patient is more sensitive to both depolarizing and nondepolarizing muscle relaxants.
- MAC is decreased

Question 24

What is the normal range of Mag during treatment?

Answer 24

4-7 mg/100ml

Question 25

At what range would you expect loss of deep tendon reflexes when using Mag?

Answer 25

8-10

Question 26

When using Mag, At what range would you expect respiratory depressing, cardiac conduction defects?

Answer 26

10-15

Question 27

What are the cardiac conduction defects you would expect when Mag levels are high?

Answer 27

wide QRS and lengthened PR interval

Question 28

When the Mag level reaches 20 or more, what would you expect?

Answer 28

Cardiac arrest

Question 29

What is the treatment of Mag overdose?

Answer 29

Calcium gluconate or CaCl

Question 30

Tocolytic therapy - when using Terbutaline or Ritodrine (Beta agonists) what side effects are common?

Answer 30

N/V Anxiety, restlessness Hyperglycemia, hyperinsulinemia, hypokalemia, acidosis Tachycardia, arrhythmias, dec peripheral VR, Edema PULMONARY EDEMA (1-5%)

Question 31

Fetal mortality risk is ____ to _____ times greater for twins vs single births

Answer 31

5-6

Question 32

mother carrying multiple babies is at no different risk of hemorrhage than single gestation mothers?

Answer 32

UNTRUE - please place a large bore IV in multiple gestation mothers

Question 33

What is a great drug for uterine relaxation during c-section for multiple gestation?

Answer 33

Nitroglycerin 100mcg initial repeated to dose of 500mcg max

Question 34

What LA is preferred for use in mulitple gestation epidural?

Answer 34

2-chloroprocaine 3% preferred due to rapid onset

Question 35

Signs and symptoms of Uterine Rupture

Answer 35

- Sudden abdominal pain despite functioning epidural - Vaginal bleeding - Hypotension - Cessation of labor - Fetal distress – most reliable sign

Question 36

what are some risk factors associated with uterine rupture?

Answer 36

``` Previous uterine surgery Trauma Multiparity Uterine anomaly Oxytocin Placenta percreta Tumors Macrosomia Malposition ```

Question 37

What is an absolute indication for having a c-section?

Answer 37

Transverse Lie

Question 38

What does "presentation" refer to?

Answer 38

most dependent or presenting part of the infant

Question 39

What does "Lie" refer to?

Answer 39

Long axis of infant (longitudinal vs transverse) | **most common is longitudinal (vertex or breech)

Question 40

What position will have the greatest chance of uncomplicated spontaneous delivery?

Answer 40

Vertex position, flexed c-spine with chin to chest, Occiput anterior (face down)

Question 41

What is the main cause of fetal demise?

Answer 41

cord accidents

Question 42

What age is considered postmaturity?

Answer 42

42 wks

Question 43

What are some complications of postmaturity?

Answer 43

decreased placental blood flow umbilical cord compression meconium staining macrosomia, shoulder dystocia

Question 44

What are some typical umbilical cord accidents?

Answer 44

``` prolapsed umbilical cord monoamniotic twins umbilical cord length (72cm) Cord entanglement (nuchal cord) Torsion ```