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31 Cards in this Set
- Front
- Back
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Definition and Causes of Pre term labour |
>20wks GA<37wksGA Idiopathic, smoking, multipl gestation infection uterine abnormalities |
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RF for preterm labour |
smoking mltp gestation pHx preterm labour Drug use low SES |
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Mgt of preterm labour? |
OBS consult prophylactic AB-underdeveloped IS (PEN-G) Celestone- lung maturation if <34wks Tocolytics if <28 wks - stop/ decrease contractions Birth/Delivery |
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When can premature rupture of membranes (PROM) |
any GA |
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your pregnant patient is concerned about the clear liquid that is leaking from her vagina. what is your DDx |
PROM urinary incontinence loss of mucous plug leukemia |
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You do a nitrazine test and its positive for alkaline what can cause a false positive? |
-Semen -Alkaline urine -blood -mucous |
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If your patient has PROM at term how will you manage? |
-celestone for fetal lung devel -AB, bed rest, OB consult - If not in labour, do NOT complete a speculum exam -if GBS+ induce immediately -if GBS- can wait to induce 24hrs |
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"Your baby is breech" what positions could this mean? |
-Frank "Pike" -Complete "Cannon ball" -incomplete (foot is slipping out) |
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Are there risk factors for having a breech baby? |
-Prematurity -Uterine Malformation -Fetal abnormalities -Placenta Previa -Polyhydraminos -Multiple Gestations |
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How will you tell that your pt baby is breech? and what can you do? |
-Palpation of head by funds -Fetal HR above umbilicus -Presentation of foot/buttocks in labour US to confirm, >36wks Leopold manouvers External cephalic version in utero rotation of fetus consider tocolytics |
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what are the types of deliveries for breech babies |
Spontaneous: typical with premature Assisted Breech: baby delivers up to torso, and needs assistance to clear the shoulders arms and head Total Breech: i.e. twins |
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Is it possible to have a vaginal birth post c section? |
yes!, If there is a known Hx, low lying scar. No! If there is a known Hx, vertical scar from previous c section, or sx OR unknown Hx OBS |
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What are the contraindications to a bag birth post c-section |
-Macrosomia -Cephalo Pelvic Disproportion -Previous inverted T incision/unknown Hx -pHx Uterine Rupture - |
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Your patient is >41 weeks pregnant |
-offer induction if no infection, asphyxia, meconium ileus,macrosomia, dystocia, fetal distress Complete NST x2 weekley, -membrane sweeping (int cervical exam)attempt to dilate cervix, 360degree sweeps to separate mbrns |
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Your patient, a pregnant woman of 30wks GA, comes in nervous because her baby has not moved . What could this be and what are you going to do to investigate? |
Dx: IU Fetal Death
Invx: dopplar US, SFH, Hx of mvt |
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what are some causes of this? |
-Cord Prolapse -Infxn -DM -Smoking |
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What are the normal parameters of labour |
2hr active labour 5cm dilation decent into the pelvic girdle |
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When should you be concerned that something is not right ? |
Delay of labour or decent of presenting part: >4hr active labour <5cm dilated >1hr w no decent in active labour (CPD) |
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What can cause abnormal progression of labour? |
Power: insufficient contractions/fatigue Passenger: position, macrosomia Passage: bladder, vagina, CPD |
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Its been 6hr of active labour, what can you do |
IU pressure cath to determine the strength of contractions Oxytocin to induce contractions /increase strength If dilated<5cm/hr oxytocin |
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Its now been 21hrs and the patient is begging for this to be over. What can you do now? |
stop analgesia Oxytocin Rest, Consider a c section |
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A baby is delivering and rapidly present s with shoulder dystocia what are the complications of this? |
Mat: 4th degree laceration, post partum hemorrhage Fetus:brachial plexus injury, #clavical, hypoxia, death |
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What are you going to do? |
Ask for help (in case the following fail) Leg hyper flexion Ant shoulder disimpaciton pressure Rubin Maneuver Manual delivery posterior arm Episiotomy Roll on to all 4s and repeat maneuvers |
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When are forceps indicated to assist in delivery? |
prolonged 2d stage of delivery, vaginal breech, avoiding c section |
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When is a Csection indicated |
Placenta Previa, Abruption , cord prolapse, CPD,Pre-eclampsia, Eclampsia, uterine rupture prev Hx C section, DM macrosomia |
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What are the major complications with uterine rupture |
mat: Shock, hemohorrage, DIC, mortality Fetus: Hypoxia, anoxia, acidosis, mortality |
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you have a female pregnant patient in the ed,. you suspect uterine rupture. what is her CP and what investigations will you do |
Shock, vaginal bleeding, painful uterus and abdo, cessation of uterine contractions, loss of palpable fetal parts! U/S abdo and ex lap- DELIVER! and stabilize mom |
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What is chorionamnionitis and how does it happen? |
inflammation of the chorionic membranes and amniotic fluid. Bacteria travels up the vagina to the uterus and leads to a rupture of membranes |
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What will your pt with chorionamnionitis present with ? |
Cold clammy skin, diaphoresis, uterine tenderness, foul odour, mat and fetHR tacky |
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how will you confirm this Dx? |
internal pelvic exam, cbc, us, amniocentesis if 14-16 weeks. |
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What are the complications of Chorionamnionitis how will you treat? |
Maternal: AROS, Csec, endometrionitis sepsis Fetal: Inxn, pnuemonia, meconium aspiration, menengitis, sepsis Tx: ampicillin +gentamycin |
