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13 Cards in this Set
- Front
- Back
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What are the only valid reasons to induce labor and what is NOT considered a good reason?
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CONVENIENCE IS NOT A GOOD REASON!
Good Reasons: 1. (true) post dates 2. clinical indication -non reassuring NST or low BPP -oligohydramnios -IUGR -PIH -GDM on insulin -hx of previous stillbirth at term |
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What is considered a true post date pregnancy?
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Pregnancy lasting beyond 42 weeks
-prolonged pregnancy -post date pregnancy -postmaturity 294 days beyond the LMP |
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What is the definition of a stillbirth and how often does it occur?
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death before delivery after 20 weeks
collective incidence of 6 per 1000 |
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Is the cause of the rise in incidence of stillbirth after 40 weeks known?
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No, it is not clearly understood
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What are the stillbirth rates per 1000 between 40-43 weeks?
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1/1000 at 40wks
1.5/1000 at 41wks 1.8/1000 at 42wks 2.9/1000 at 43wks |
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When does ACOG recommend induction?
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-consider induction in pts >41 weeks with a favorable cervix
-if cervix is unfavorable, semiweekly testing or induction are "equally reasonable options" |
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How is dating done?
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1. 1st tri scan
2. 2nd tri scan 3. good LMP 4. 3rd tri scan -Anticipatory guidance: EDB 4 wk range. -Optimal length of gestation is truly not known, 42 weeks as “post dates” is arbitrary. |
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When should you do an NST/AFI?
And if expectant managing, when would you decide induce and no longer do NST/AFI? |
-NST at 41+0 & 41+3or4
-AFI at 41+0 -Induce at 42+0 |
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What is the minimum gestation for induction? If you needed to induce before this time, what criteria would need to be present?
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-39 weeks
-Must have an amnio for fetal lung maturity, and/or strong medical indication (preferably both) |
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How does induction increase the cesarean section rate according to risk factors of parity, chronic HTN, fibroids, fetal weight >4K, and GA >42wks?
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Case Study 1:
-28 yr old primip at 40 1/7 wks -Prodroming for 4 days, in triage every 12 hours -Asks: “why can’t you induce my labor? -Her cervix gives a bishop score of 3 -Her NST is ok -Her AFI is ok |
What would be your management?
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Case Study 2:
-Multip 35 yrs old somali woman 42 3/7 -Only 2 pn visits in last month -Now in yr exam room -No antenatal testing -God will take care of me |
What would be your management?
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Case Study 3:
41 3/7 wk primip Bishop score 2 -NST non reactive with variable to -80’s -AFI 10 |
What would your management be?
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