Repro - Ob-Gyn - Ptl, Abnormal Labor

Front 1

Definition of PTL:

PTB:

Very PTB, Extreme PTB:

4 primary processes for PTB:

Back 1

>20 weeks, <37 weeks

birth <37 weeks

Very - 32-34 weeks
extreme - <28 weeks

activation of maternal/fetal HPA axis, infection, decidual hemorrhage, pathological uterine distension

Front 2

Major risk factors for PTB:

S/S of PTL:

Dx of PTL:

Back 2

multiple gestations
IVF
past PTB
vag bleeding, 2nd trimester
Infection
<18 y/o
mother's low BMI
cigarette smoking

menstrual-like cramping, constant low back pain, mild contractions, bloody show

regular, painful uterine contractions w/ cervical dilation, effacement
PUC 4/20 minutes, 8/60 minutes
80% effaced, >2 cm dilation

Front 3

Explain cervical length triage:

Management <34 weeks:

Back 3

>30 mm - low risk of PTB regardless of fFN
20-30 mm - PTB more likely, check fFN
<20 mm - high risk of PTB regardless of fFN

glucocorticoids, Abx, tocolytic drugs

Front 4

Initial tx for PTL, and goal:

Goals for tocolysis:

Only FDA approved drug for PTL:

Other drugs to use:

Back 4

Obs/rest, hydration, maternal postition (L side) - increase utero-placental perfusion

delay delivery for 48h after steroids, delay delivery until 34 weeks

ritodrine, seldom used- usually terbutaline

CCB's, B agonists, PG synthase inhibitors, Mag sulfate

Front 5

What should you check with Mag sulfate use?

When not to stop PTL:

Prognosis of LBW infants:

Back 5

repiratory arrest due to toxic levels (>12 mg - cardiac arrest), renal function

severe HTN, pulmonary/cardiac disease, advanced cervical dilation (>4 cm), unstable hemorrhage

2000-2500 g - 97%
1500-2000 g - 90%
1000-1500 g - 65-80%
800-1350 g - 66%

Front 6

Definitions:
Attitude
Lie
Presentations
Point of reference
Position

Back 6

attitude - posturing of joints, fetal parts relationship to each other - normal fetal attitude during labor is flexion of all joints
lie - longitudinal axis of fetus to mother
presentations - part of fetus over pelvic inlet/cervical os
point of reference - arbitrary point on part to orient to pelvis
position - POR relation to pelvic inlet

Front 7

Biparietal diameter is at or below true pelvic inlet:

presenting part's relationship to ischial spine:

result of active forces of labor:

normal head movement to negotiate pelvic curve:

Back 7

engagement

station

descent

extension

Front 8

Explain Int Rot/Ext Rot:

Expulsion:

Normal, abnormal latent phase in labor:

Back 8

internal - impingement of presenting part on pelvis
external - spontaneous realignment of head with shoulders

A/P shoulders, followed by trunk, LE's

nulliparous - 8h; multiparous - 5h
abnormla - >20h, >12 h

Front 9

Average 2nd stage time:

Score used to measure cervical ripeness:

Abnormal labor is usually a problem with what 3 P's?

Definition of labor power:

power must exceed what to be adequate?

Back 9

N - 50 min; M - 20 min

Bishops score

passenger, pelvis/passage, power

uterine contractility x frequency

200 MVU

Front 10

How to measure MVU's:

Prolonged latent phase?

Most common cause:

Back 10

uterine pressure above baseline x contractions q 10 minutes

onset of regular UC's to onset of active phase (N - >20h, M - >14h)

entering labor w/o substantial cervical effacement

Front 11

Values for:
protracted dilation
protracted descent
prolonged 2nd stage
secondary arrest of dilation
arrested descent

Back 11

dilation - N <1.2 cm/hr, M <1.5 cm/hr
descent - N <1 cm/hr, M <2 cm/hr
2nd stage - w/o epidural - N >2h, M >1h
secondary arrest - N/M >2h
arrested descent - no mvmt for 1h
w/ epidural - N >3h, M >2h

Front 12

<3h total duration from contractions to delivery:

Best tx for prolonged latent phase:

Management of prolonged active phase:

Back 12

precipitous labor

Obs

if <200 MVU's, give oxytocin, hydration, see if labor can continue
if >200 MVU's and no labor, consider operation

Front 13

Tx of prolonged 2nd stage:

Management of secondary arrest of dilation:

Back 13

consider vacuum/forceps

augment labor if safe beyond 2 hrs if fetus is OK