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high risk OB > PTL, PPROM, chorio, multiple gestation > Flashcards

PTL, PPROM, chorio, multiple gestation Flashcards

1
Q

-gestation 20 to <37 weeks
-uterine cxs
-cervical changes

A

preterm labor

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2
Q

gestation 20 to <37 weeks
birth

A

preterm birth

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3
Q

3 categories of preterm

A

very preterm: <32.0
moderately preterm: 32.0-33.6
late preterm: 34.0-36.6

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4
Q

3 categories of term

A

early term: 37.0-38.6 weeks
full term: 39.0-40.6 weeks
late term: 41.0-41.6 weeks

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5
Q

what is considered low birth weight

A

<2500 grams at birth

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6
Q

*lowdermilk box 32-1 and 32-2

A
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7
Q

factors that may explain increase in preterm birth rates

A

-increase twins and multiples from IVF
-increased births to AMA moms
-increase medically induced prematurity
-early repeat C/S
-C/S w/o medical indications
-advances in MFM and NN care
-increase pregnancies in HR women
-increased fetal complications requiring early birth (ex : IUGR)

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8
Q

potential triggers of inflammation

A

-microbial invasion amniotic cavity
-maternal obesity
-uterine overdistention
-subclinical genital tract infections

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9
Q

stimuli from an inflammatory response causes a withdrawal of functional progesterone

A

inflammatory response

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10
Q

examples of pathways of interaction of factors

A

-inflammation
-maternal/fetal stress
-abnormal uterine distention
-bleeding/thrombophilia
-hormones/toxins

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11
Q

big 3 risk factors for PTB

A

-current multifetal pregnancy
-h/o PTB
-uterine/cervical abnormalities

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12
Q

medical condition risk factors for PTB

A

-DM
-HTN
-clotting disorders
-previous 2nd tri abortion
-inadequate nutritional status (underweight/obese, inadequate weight gain, anemia)
-infections
-abnormal lipid metabolism

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13
Q

demographic risk factors for PTB

A

-age (<17 or >35)
-AMA
-low socioeconomic status
-black race
-tobacco
-substance abuse
-maternal/fetal stress

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14
Q

behavioral/environmental risk factors for PTB

A

-substance abuse
-DES exposure
-maternal/fetal stress
-intimate partner violence
-lack of social support
-long working hours
-long periods standing
-exposure to environmental substances (pollution, radiation, lead, paint, smoke)

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15
Q

pregnancy associated risks for PTB

A

-late/no prenatal care
-vaginal bleeding (esp 2nd/3rd tris)
-PPROM
-short interpregnancy interval (<18 mos)
-changes maternal microbiome
-fetal anomalies

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16
Q

when would fetal fibronectin be found in vaginal fluid

A

disruption in chorion
good for predicting you won’t go into labor
fFN shouldn’t be in vaginal fluid normally between 24-34 EGA

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17
Q

what factors could affect the accuracy of the fFN test for PTL

A

-ROM
-sexual intercourse past 24 hrs
-cervical examination/vaginal ultrasound past 24 hrs
-vaginal bleeding
-infections (intraamniotic/vaginal)
-douche/vaginal lubricant use

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18
Q

two tests for PTL/PTB

A

fFN
PAMG-1

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19
Q

what is considered a short cervix

A

<25 mm @16-24 EGA

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20
Q

who might get a cervical cerclage

A

h/o PTB @17-33.6 EGA
cervical length <25 mm before 23 EGA
only best for singleton pregnancies

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21
Q

who might receive progesterone

A

h/o PTB
cervical length <20 mm @ <24 EGA
*started at 15-20 weeks until 36 weeks

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22
Q

meds that inhibit contractions

A

tocolytics

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23
Q

when can tocolytics be given

A

22-33.6 wks EGA

24
Q

4 tocolytic meds

A

-mag sulfate: CNS depressant, smooth muscle relaxant
-terbutaline/brethine: beta mimetic
-indocin: NSAID
-nifedipine (adalat, procardia): CCB

25
general contraindications for tocolytic meds
-acute fetal compromise -intraamniotic infection/chorio -eclampsia/severe preeclampsia -fetal demise -fetal maturity -placental abruption -maternal bleeding with instability -pulmonary HTN -PPROM (except for steroid admin and transfer) *basically anything that means birth is imminent
26
contraindications to terbutaline
-tachycardia sensitive maternal cardiac disease -poorly controlled maternal DM -maternal hyperthyroidism -maternal seizure disorders
27
contraindications to mag sulfate
-maternal hypocalcemia -maternal myasthenia gravis -maternal renal failure
28
contraindications to indomethacin
-gestation >32 weeks -maternal asthma -maternal coronary artery disease -maternal GI bleeding -platelet dysfunction/bleeding disorder -oligohydramnios -renal failure -suspected fetal cardiac/renal anomaly -maternal liver disease -IUGR
29
contraindications to nifedipine
-maternal CV disease -maternal aortic insufficiency -maternal hemodynamic instability -maternal hypoTN -no combo with beta mimetic drugs
30
purpose of giving mag sulfate for PTL/PTB
decreased incidence cerebral palsy NN neuroprotection
31
purpose of giving betamethasone/dexamethasone for PTL/PTB
DECREASED INCIDENCE OF: -RDS -intraventricular hemorrhage -NEC -NN death
32
S+S PTL pt teaching
-malaise/discomfort/fatigue -uterine activity (Cxs q10mins, cramping like period) -low dull backache -suprapubic pain/pressure -feeling baby is pushing down/balling up -vaginal discharge (increased amount or change) -urinary frequency
33
pt teaching what to do if S+S PTL
-empty bladder -lateral rest 1 hr -palpate for ctx -if continues/worsens call hcp or go to clinic
34
when should woman go to clinic/birth facility immediately (S+S)
-ctx q10mins for 1 hr + -vaginal bleeding -fluid leaking from vagina -odorous vaginal discharge
35
spontaneous rupture of amniotic sac and leakage of fluid prior to onset of labor at any EGA
premature rupture of membranes PROM
36
membranes rupture before 37.0 weeks EGA
preterm premature rupture membranes PPROM
37
PPROM risk factors
-low socioeconomic status -poor nutritional status -tobacco/substance abuse -infection (including h/o STDs) -incompetent cervix -trauma
38
Tx PPROM for >34 weeks EGA
delivery
39
Tx PPROM for32-34 weeks EGA
assess fetal lung maturity mature: deliver
40
Tx PPROM for <32 weeks EGA
expectant management: -fetal assessment -monitor for complications -abx 7 days -glucocorticoids
41
risk factors chorioamnionitis
-ROM -maternal malnutrition, poverty, substance abuse -repeated vaginal exams -internal monitoring in labor -vaginitis, cervicitis, previous cerclage
42
Dx chorio
-maternal fever (>39 C once, >38 C twice, >38 + additional criteria) -fetal tachy (>160) -leukocytosis (>15k) -purulent cervical drainage -pos gram stain for bacteria
43
S+S chorio
-maternal fever -fetal tachy -leukocytosis -uterine pain and tenderness -foul smelling vaginal discharge -malaise -maternal tachy -uterine cxs
44
management chorio
-IV hydration -IV abx and oxytocin -decrease maternal temp -delivery
45
possible NN complications from chorio
-sepsis/bacteremia -pneumonia -meningitis -RDS -cerebral palsy -neurologic deficits
46
maternal body adaptations to multi fetal pregnancy
-hyperemesis -increased plasma volume (50-100% increase) -dependent edema, increased risk pulmonary edema -increased O2 consumption, increased pH -increased SOB
47
S+S of recipient twin in TTTS
-hypervolemia -polycythemia -polyhydramnios -CHF -death
48
S+S of donor twin in TTTS
-hypovolemia -anemia -growth restricted -oligohydramnios
49
Dx of TTTS
-monochorionicity -amniotic fluid discrepancy (poly and oligo)
50
timing for delivery for dichorionic twins: -uncomplicated -isolated fetal growth restriction -fetal growth restriction and coexisting condition (maternal or fetal)
uncomplicated: 38.0-38.6 isolated growth restriction: 36.0-37.6 growth restriction and coexisting condition: 32.0-34.6
51
timing for delivery for monochorionic twins: -MC/DA uncomplicated -MC/DA w isolated fetal growth restriction -MC/MA uncomplicated
-MC/DA uncomplicated: 34.0-37.6 -MC/DA w isolated fetal growth restriction: 32.0-34.6 -MC/MA uncomplicated: 32.0-34.0
52
purpose of tocolytics and how long should they be administered
can delay preterm birth up to 48 hrs (but not prevent it) dont admin for >48 hrs
53
side effects mag
drowsiness decreased RR arrhythmias bradycardia hypoTN diarrhea muscle weakness flushing sweating hypothermia
54
side effects nifedipine
headache arrhythmias HF peripheral edema flushing stevens-johnson syndrome
55
main difference between testing fFN and PAMG-1 for PTB/PTL
-PAMG-1 testing is less affected by other factors (recent vaginal exam) -PAMG-1 higher negative predictive value

high risk OB (14 decks)

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