Pregnancy, Labor Induction, Preterm Labor, Prematurity

Front 1

Pregnancy lasts ____ days (___ weeks)

- Calculated from the first day of ____

-Trimesters divided in to __weeks-__ weeks-___ weeks

Back 1

280 days, 40 weeks

- first day of last menstrual period (LMP) based on 28 day cycle

- 13;14;13

Front 2

Gravida definition

Primigravida

Multigravida

Back 2

- number of pregnancies a woman has regardless of outcome

- pregnant once

- pregnant 2 or more times

Front 3

Parity: definition

Nullipara

Primipara

Multipara

Back 3

- number of deliveries after 20 weeks gestation

- never delivered an infant after 20 weeks

- delivered an infant beyond 20 weeks

- two or more deliveries

Front 4

"Florida Power And Light"

Back 4

Full Term, Premature, Abortions, Live children

Front 5

Stage 1 of pregnancy
- Latent = ____ contractions become progressively better coordinated and cervix effaces and dilates to ___ cm

- Active: the cervix becomes fully dilated and the presenting part descends well into the ____

Back 5

- irregular; 4cm

- midpelvis

Front 6

Stage 2 of pregnancy

- Time from full ____ to delivery of fetus

Back 6

- cervical dilation

Front 7

Stage 3 of pregnancy

- begins after ____ and ends with ____
- highest risk of ____

Back 7

- after delivery; delivery of placenta
- hemorrhage

Front 8

This is defined as a purposeful stimulation of uterine contractions for the goal of delivery prior to the onset of spontaneous labor

Back 8

- Induction

Front 9

Contraindications to induction of labor

Back 9

"PAF PAPI"

- placenta or vasa previa
- abnormal fetal lie (breach)
- Funic presentation (cord prolapse)
- Prior classical uterine incision
- Active genital herpes
- Pelvic structural deformities
- Invasive cervical carcinoma

Front 10

Chorioamnionitis, cesarean delivery, iatrogenic prematurity, respiratory morbidities in newborn are risk of ____

Back 10

Induction

Front 11

Should not induce prior to ____ weeks and should be at least 36 weeks since last ______; 30 weeks since ____ detected on doppler

Back 11

- 39 weeks
- positive pregnancy test
- heart rate

Front 12

For induction, a Bishop score of <6 indicates what?

Bishop score >6 indicates what?

Bishop score >9 indicates what?

Bishop score <4 indicates what?

Back 12

<6 = unfavorable cervix; may require ripening agent

>6 = favorable cervix, agent inducing contractions

>9 = success

<4 = failure

Front 13

Nonpharma methods for cervical ripening- name some

Back 13

- Membrane stripping
- Sexy time
- Nipple stimulation (tassels optional)
- Herbs/Homeopathy
- Castor oil
- Enemas (no thanks)
- Acupuncture
- Amniotomy

Front 14

True or false: Misoprostol is an FDA approved agent for cervical ripening

- Given ___ug tab q ___ hours

- Not recommended if >___ contractions in 10 minutes

- Side effects

Back 14

- False- off label

- 25 ug, Q4 hours

- > or equal to 3 in 10 minutes

- SE = uterine hyperstimulation

Front 15

Dinoprostone
- what is it used for?
- Brand names?

Back 15

- cervical ripening
- Prepidil, Cervidil

Front 16

Dinoprostone:

Prepidil = __mg placed _____

Cervidil ___mg placed _____ in the posterior fornix of the vagina; inserts release ___mg/h for 12 hours

- Patient should remain recumbent for __-___ min

- Side effects

Back 16

- 0.5 mg; intracervical

- 10 mg; transversely; 0.3mg/hr for 12 hours

- 30-60 min

- uterine hyperstimulations

Front 17

True or false: some studies have shown that Cervidil is better than Prepidil (both dinoprostone).

Back 17

True

Front 18

Oxytocin
- what's it used for?
- given via ____ infusion or in ____ed dosed as

- starting dose: __-__ mU/min with increases every __-__ minutes

- Adverse effects

Back 18

- labor induction
- continuous; pulsed

- 0.5-2.5 mU; 15-60 minutes

- uterine hyperstimulation; hyponatremia (water intox), hypOtension related to infusion rate

Front 19

Preterm labor
- defined as cervical changes and uterine contractions that occur before ___ weeks gestation or:

- dilation >___cm with effacement > ___% and regular uterine contractions

Back 19

- 37

- >2cm; >80%

Front 20

True or false: cervical length is inversely related to the risk of preterm birth?

Back 20

True
- the greater the length = decreased risk

Front 21

What is fetal fibronectin used for?

Back 21

- to predict the risk of preterm delivery

- if its present, there's a 75-80% chance you'll deliver in 14 days

Front 22

What is the leading cause of infant morbidity and mortality?

Back 22

preterm labor

Front 23

____ is also known at 17-OHP

- indication: history of spontaneous preterm birth <___ weeks

- moa?

- given via weekly __ injection

Back 23

- progesterone (17-alpha-hydroxyprogesterone)
- 37 weeks

- not fully understoon- naturally occuring steroid

- IM

Front 24

Nonpharm therapy for treatment of preterm labor

- modified _____
- ___alysis
-_____ (orally or parentally)

- is there a proven benefit?

Back 24

- bed rest
- urinalysis
- hydration

- no

Front 25

___ weeks gestation defines a point at which early pregnancy loss is less commonly attributable to karyotypic abnormality

- delivery prior to ___ weeks is considered a spontaneous abortion rather than preterm birth

Back 25

-15 weeks

- 20 weeks

Front 26

Goal of tocolysis:

- prolonging delivery for ___week(s) can decreased neonatal morbidity and mortality up to __15

- neonatal morbidity is substantially decreased at >___ weeks

Back 26

- 1 week; 15%
-34 weeks

Front 27

Does tocolysis prevent preterm deliver?

Back 27

Rarely

Front 28

Purpose of Tocolytic Therapy

- stop ___ and prolong delivery for at least __-__ hours in 75-80% of women

- postpone delivery for admin of antenatal _____ to improve pulmonary maturity

Back 28

- contractions; 48-72 hours
- corticosteroids

Front 29

Maternal factors precluding tocolysis

-_____amnionitis
- pre-______
- _._._._._ syndrome
- hemorrhage
- advanced labor

Back 29

-CHORIOamnionitis
-pre-ECLAMPSIA
-HELLP (increased LFTs, liver distress)

Front 30

Medications Used for Tocolysis

- ___ sulfate
- ________ agonists
- _____ inhibitors
- ____ ____ blockers
- antenatal _____ admin
-____ therapy

Back 30

-Magnesium sulfate
- B-Adrenergic agonists
- COX-2 inhibitors
- Calcium Channel blockers
- antenatal glucocorticoids
- antibiotic therapy

"MAC BAC"

Front 31

What is the most frequently used parenteral tocolytic?

- what else is it prescribed for?

- what is its MOA?

- antagonizes ____ at the cellular level and in the extracellular space

Back 31

Magnesium sulfate

- eclampsia

- relaxes urterine smooth muscle and decreased myometrial contractility

- calcium

Front 32

Mag Sulfate Dosing:

loading dose: __ mg IV over ___ min

Continuous IV infusion: __g/hr through controlled infusion pump

- how is it excreted?

- dose it cross the placenta?

Back 32

- 6 mg; 30 min

- 2 g/hr

- renally

- yes

Front 33

_____ is probably as effective as B-adrenergic agonists, terbutaline, ritodrine in postponing preterm delivery for 48 hours

- it is also associated with a decreased risk of ____ and ____ in neonates

Back 33

- Magnesium

- cerebral palsy; mental retardation

Front 34

Contraindications to Magnesium:

1. hypo___
2. _____ ____
3. ___ failure

Back 34

-hypoCALCEMIA
- myasthenia gravis
- Renal failure

Front 35

Magnesium may be increased ___g/hr until <__ contractions per 10 minutes.

Max dose of ___gm/hr

myometrial contractions are inhibited with concentrations of __-__ mg/dL

Back 35

- 1 g; <1 contraction

- 4 g

- 6-9.6 mg/dL

Front 36

True or false: serum concentrations of Mg are linearly related to its efficacy?

Back 36

FALSE

Front 37

Magnesium Monitoring:
1. ___ ___ reflexes hourly
2. ____ rate hourly
3. ___ output (__=__ hours)
4. ___ balance
5. _____ serum levels (__-__ hours)

Back 37

1. deep tendon
2. respiratory
3. urine, 2-4 hrs
4. fluid balance
5. Mag q 6-12 hrs

Front 38

Magnesium Side effects for the mom

- associated with loading dose?

- (HYPO/HYPER)thermia
- paralytic ___
- ____ edema

Back 38

- transient hypOtension; flushing; sense of warmth, HA, dizziness, lethargy, blurred vision, diplopia, dry mouth

- hypO
- ileus
- pulmonary edema

Front 39

Neonatal side effects of Magnesium

- (HYPER/HYPO)tonia
- (HYPER/HYPO)calcemia
-_____ness
- ____ intolerance
- ______ depression

Back 39

- hypOtonia
-hypOcalcemia
- sleepiness
- feeding intolerance
- neuromuscular depression

Front 40

_____ ____ are considered second line for tocolysis

-_____ is one of these and is available IV, SQ, and PO

Back 40

- B-adrenergic agonists

- terbutaline

Front 41

Terbutaline admin

Acute: (Route?) 0.25 mg every __-__ min for up to __ doses until tocolysis achieved

Maintenance: (Route) 2.5-10 mg every __-__ hours for as long as necessary to prolong pregnancy depending on pt tolerance

Back 41

-SubQ; 20-30min; 4 doses

- PO; 4-6 hrs

Front 42

True or false: B-adrenergic agonists such as terbutaline reduce the rate of preterm delivery?

Back 42

False

Front 43

Adverse Effects of Beta Agonists for the MOM:

1. ___ edema
2. palpitations
3. (TACHY/BRADY)cardia
4. ____ ischemia
5. (HYPER/HYPO)glycemia
6. (HYPER/HYPO)kalemia
7. ____ toxicity

Back 43

1. pulmonary edema
2. palpitations
3. tachycardia (hold if >120 bpm)
4. Myocardial ischemia
5. hypERglycemia
6. hypOkalemia
7. hepatotoxicity

Front 44

Fetal adverse effects of Beta Agonists:

1. (BRADY/TACHY)cardia
2. (HYPER/HYPO)tension
3. (HYPER/HYPO)glycemia
4. (HYPER/HYPO)calcemia
5. increased risk of _____ hemorrhage

Back 44

1. Tachycardia
2. HypOtension
3. hypOglycemia (mom is hypER)
4. hypOcalcemia
5. intraventricular

Front 45

Indomethacin is a _____ inhibitor and is used as a ____ agent

- often used when women have failed with _____

- prostaglandins ___ and ___ are important regulators of myometrial contractility

Back 45

- COX; tocolytic

- magnesium

- F-2alpha; E2

Front 46

Indomethacin

Loading dose: 50-100 mg given ___ or ___

Maintenance: ___ - ___ PO every __-__ hours for 24-48 hours

Back 46

- Rectally or PO

25-50 mg; q 4-8 hours (6 is most common)

Front 47

True or false: Mag and Beta agonists are more effective than indomethacin in delaying delivery for 48-72 hours

Back 47

- False- Indo is as effective as both

Front 48

In a meta-analysis of tocolytics, which of the following was the only one to decrease preterm birth and birth weight <2500 g?

A. Beta agonists
B. Indomethacin
C. Magnesium

Back 48

C- indomethacin

Front 49

Maternal AEs of Indomethacin

"GREEN P"

Back 49

Gastritis

Renal toxicity

Esophageal Reflux

Emesis

Nausea

Prolonged bleeding time

"GREEN P"

Front 50

Fetal AEs of Indomethacin

"aNDROId"

Back 50

Necrotizing enterocolitis

Ductal constriction

Renal failure

Oligohydramnios

Intraventricular hemorrhage

"aNDROId"

Front 51

What CCB is used as a tocolytic agent?

- duration of tx typically continued through the ___th week of gestation

Back 51

Nifedipine

- 34th

Front 52

Nifedipine Dosing

Loading dose: ___mg PO followed by additional ___mg in 90 min
or
__mg PO followed by additional ___ mg every 20 min for up to 4 doses

Maintenance: __-__ mg PO q 4-6h

Back 52

LD: 20; 20
or
10 mg; 10mg

Maintenance: 10-20mg

Front 53

True or false: studies have shown that nifedipine is more effective compared to B-adrenergic agonists in reducing the number of preterm births within 7 days before 34 weeks?

Back 53

True

Front 54

Maternal Side Effects of Nifedipine

1. (TACHY/BRADY)cardia
2. headache
3. flushing
4. dizziness
5. nausea
6. (HYPER/HYPO)tension
7. Contraindicated with ____ due to increased suppression of muscular contractility

Back 54

1. Tachycardia

6. hypOtension

7 CI'd with Magnesium

Front 55

Fetal side effects of Nifedipine

Potential for reducing ____ and ____ blood flow.

- has this been confirmed in humans?

Back 55

- uterine and umbilical

- no

Front 56

Nitric oxide donors and oxytocin-receptor antagonists are used for what purpose?

Back 56

tocolysis

Front 57

____ are given to facilitate fetal lung maturation

MOA: act on the type ___ pneumocytes to induce the syntheses of precursors for ____ and increase the production of ________

- given to all women in preterm labor between ___-___ weeks gestation

Back 57

- antenatal glucocorticoid

- type II; surfactant; phophatidylcholine

- 24-34

Front 58

Glucocorticoid Dosing

Betamethasome ___ mg IM x 2 (__ hours apart)

Dexamethasone __ mg IM x 4 (__ hours apart)

Clinical effects can be seen for __-__ weeks

Back 58

- 12 mg; 24 hours

- 6 mg; 12 hours

- 1-2 weeks

Front 59

What is the time elapsed between the first day of the last normal menstrual period and the day of delivery

Back 59

Gestational Age

(expressed as COMPLETED weeks- 25 week 5 day old fetus is still 25 weeks)

Front 60

What is the time elapsed between the day of conception and the day of delivery?

Back 60

Conceptional age

Front 61

What is the time elapsed since birth?

Back 61

Chronological age

Front 62

What is the gestational age + chronological age?

Back 62

Postmenstrual Age

Front 63

_____ age is calculated by subtracting the number of weeks born before 40 weeks gestation from the chronological age

_____ = Weeks before 40 - Chronological age

Back 63

Corrected age

Front 64

Birth Weights

Average Full term: ___ g

Low <____ g

Very low <____g

Extremely low <____ g

Back 64

- 3500 g

- 2500 g

- 1500

- 1000 g

Front 65

Birth Weight

Small for gestational age <___th percentile

Appropriate for gestational age between ___th and ___th

Large for gestational age >___th

Back 65

- <90th percentile

- between 10 and 90

->90th

Front 66

What are some major complications of premature birth?

1. _____ distress syndrome
2. _____ of prematurity
3. (HYPER/HYPO)thermia
4. (HYPER/HYPO)bilirubinemia

Back 66

1. respiratory
2. apnea
3. hypO
4. hypER

Front 67

What is a major sign of respiratory distress syndrome Dr. Gore emphasized?

Back 67

Grunting

Front 68

What are treatment options for respiratory distress?

1.
2.
3.
4.

Back 68

1. oxygen
2. mechanical ventilation
3. fluid restriction
4. surfactant

Front 69

True or False: Synthetic surfactants are superior to natural type and improve survival, have fewer comorbidities, faster onset of action, and decrease dependence on mechanical ventilation?

Back 69

False!!

Natural is better

Front 70

Surfactants:

1. ____ is the ferrari of surfactants and it porcine derived

2. ____ is bovine derived

3. ____ is used least and is bovine derived

Back 70

1. Curosurf (poractant alfa)

2. Infasurf (calfactant)

3. Survanta (beractant)

Front 71

Adverse Effects of Surfactant Therapy:

1. (TACHY/BRADY)cardia
2. (HYPER/HYPO)tension
3. _____ desaturation
4. Cyanosis
5. ____ obstruction
6. pneumothorax
7. apnea
8.______ hemorrhage
9. pulmonary interstitial _______

Back 71

1. Bradycardia
2. hypOtension
3. oxygen desaturation
4.
5. airway obstruction
6.
7
8. pulmonary hemorrhage
9. emphysema

Front 72

Apnea definition:

cessation of breathing for >___ seconds or less if accompanied by ____, sifnificant ______, or _____

Back 72

>15 (or 20 seconds)

bradycardia, hypoxemia, cyanosis

Front 73

In this type of apnea inspiratory efforts are absent

Back 73

Central apnea

Front 74

In this type of apnea inspiratory efforts persist but obstruction is present

Back 74

Obstructive apnea

Front 75

In this type of apnea, airway obstruction with inspiratory efforts precedes or follows central apnea

Back 75

Mixed apnea

Front 76

Apnea Treatment Options

1. supplemental ______
2. continuous _____ _____ pressure
3. _____ pressure ventilation
4. ________ therapy
5. ______ tactile stimulation

Back 76

1. oxygen
2. airway pressure
3. positive
4. methylxanthine
5. gentle

Front 77

Treatment of Choice for Apnea?

MOA: increased levels of 3-5 AMP by inhibiting _____

Improves _____ contraction

Competitive inhibition of ____ at surface cell receptors

Back 77

Caffeine

- phosphodiesterase

- skeletal muscle

- adenosine

Front 78

Caffeine

Monitoring trough __-___ mcg/ml

Back 78

5-25 mcg/mL

Front 79

Neonatal hyperbilirubinemia is caused by (CONJUGATED/UNCONJUGATED) bilirubin?

mean peak is around ___mg/dL

Back 79

UNconjugated


7 mg/dL

Front 80

Hyperbilirubinemia Treatment?

Back 80

Light therapy between 435-472 nanometers