Term
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Definition
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Term
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Definition
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Term
| Extremely low birth weight |
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Definition
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Term
| Leading cause of neonatal mortality |
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Definition
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Term
| Mortality rate is ________ proportional to patients weight |
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Definition
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Term
| Risk factors for prematurity. Name 4. |
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Definition
| Previous preterm delivery, multiple gestation, PROM, Race |
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Term
| Race with highest incidence of prematurity |
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Definition
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Term
| Is home uterine activity monitoring a good way to determine preterm labor? |
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Definition
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Term
| Salivary estriol is elevated at least _____ weeks before delivery |
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Definition
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Term
| Salivary estriol levels peak when? |
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Definition
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Term
| Salivery estriol levels can be suppressed by what drugs |
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Definition
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Term
| Is salivary estriol levels a good way to predict preterm labor? |
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Definition
| No--high levels of false-positive results |
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Term
| If this test is positive, there is a high likely hood of preterm labor. |
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Definition
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Term
| If you suspect the pateitn is in preterm labor, what should be checked before a fetal fibronectin sample is taken? |
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Definition
| Make sure cervical dilation is minimal because speculum must be used to get sample |
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Term
| As the cervical length _______, the chance of preterm labor increases |
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Definition
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Term
| Is bacterial vaginosis a indicator of preterm labor? |
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Definition
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Term
| Diagnostic Criteria for Determining Preterm Labor. Name 4 things. |
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Definition
-Gestational age between 20-37 weeks
-At least 4 documented contractions in 20 minutes or 8 in 60 minutes
-Change in cervical dilation or effacement (dilation of 2 cm, effacement of 80%)
-Absence of fetal breathing movements |
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Term
| Best way to monitor fetal well-being |
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Definition
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Term
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Definition
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Term
| 2 Times When There is Decreased FHR Variability |
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Definition
Baby is sleeping
fetal compromise |
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Term
| Early Decels--what are they? Why do they happen? |
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Definition
| Heart rate decreases with the beginning of a contraction and slows towards the end. Caused from head compression. |
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Term
| Late Decels--what are they? Why do they happen? |
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Definition
| Decreases in HR due to hypoxia. Decreases are seen after the contractions |
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Term
| What kind of decels do you see with umbilical cord compression? |
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Definition
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Term
| Name 4 non-reassuring patterns |
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Definition
Decrease in baseline variability
Progressive tachycardia
Decrease in baseline FHR
Intermittent late decels with good variability |
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Term
| Ominous patterns. Name 3. |
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Definition
Persistent late decels
Bradycardia
Absence of variability |
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Term
| If assessing preterm labor and OB doc wants a amniocentesis, what would they be assessing? |
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Definition
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Term
| Name 4 ways to prevent preterm labor |
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Definition
Cervical cerclage
Progesterone therapy
prophylactic ABX
Beta agonist |
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Term
| Management of Preterm Labor. Name 3 drugs classes you give. |
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Definition
Antenatal corticosteroids
ABX
Tocolytics |
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Term
| Antenatal administration of Corticosteroids |
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Definition
Betamethasone 12 mg IM every 24 hours X 2
Dexamethasone 6 mg IM every 12 hours X 4 |
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Term
| Why give antenatal corticosteroids? |
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Definition
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Term
| Antenatal ABX therapy: When can this prolong pregnancy? |
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Definition
| With PROM it reduces morbidity and prolongs pregnancy. |
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Term
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Definition
| IV Ampicillin and Erythmycin X 48 hours then PO for 5 days |
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Term
| Contraindications for Tocolytic Therapy for Preterm Labor. Name 6. |
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Definition
Fetal death
Fetal anomalies incompatible with life
non reassuring fetal status
chorioamnioitis/fever unknown origin
severe hemorrhage
severe chronic and/or pregnancy-induced HTN |
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Term
| Criteria for Tocolytic Therapy |
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Definition
Gestational age between 20-34 weeks
Reassuring fetal status
No clinical signs of infection |
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Term
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Definition
Calcium channel blocker
Beta agonist
Magnesium
COX2 inhibitors |
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Term
| How do COX2i work as tocolytic? |
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Definition
| decrease intracellular Ca++ via prostaglandin inhibition |
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Term
| How does Mag work as a tocolytic? |
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Definition
| lowers intracellular Ca++ in the myometrium |
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Term
| What makes preterm infants more vulnerable to depressant effects of analgesic/anesthetic drugs than term infant? Name 5 things. |
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Definition
-Less protein available for drug binding (less protein = more free drug)
-Higher levels of bilirubin (our drugs bind to bilirubin)
-Great drug access to the CNS (neonate doesn't have well defined BBB)
-Decreased ability to metabolize and excrete drugs
-Greatest total body water and lower fat content (larger VD so it takes more drug to get the same effect) |
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Term
| Nifedipine Dose for Preterm Labor |
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Definition
Initial Dose: 20-30 mg PO or SL
Maintenance Dose: 10-20 mg every 4-6 hours |
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Term
| Side effects of Calcium Channel Blockers |
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Definition
hypotension
h/a, flushing, dizziness
pulmonary edema & MI have been reported
Decrease UBF resulting in fetal hypoxemia & acidosis. However, short term administration doesn't effect fetal circulation. |
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Term
| What COXi has been reported to have fewer fetal side effects, possibly because its active metabolite crosses the placenta less readily than the native drug |
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Definition
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Term
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Definition
| prevents synthesis of prostaglandins. prostaglandins increase uterine activity by increasing intracellular calcium |
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Term
| Dose of Indomethacin for preterm labor |
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Definition
Initial Dose: 50-100 mg PO or PR
Maintenance Dose: 25-50 mg every 4 hours |
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Term
| Dose of Ketorolac for preterm labor |
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Definition
Initial Dose: 60 mg IM
Maintenance Dose: 30 mg every 6 hours |
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Term
| Dose of Sulindac for preterm labor |
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Definition
Initial Dose: 200 mg PO
MD: 200 mg every 12 hours |
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Term
| Most common complaints of COXi |
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Definition
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Term
| T/F: Indomethacin alters materal HR & BP |
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Definition
| False--it does not alter either |
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Term
| Are COXi a contraindication for regional anesthesia? |
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Definition
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Term
| What can NSAIDs do to the fetal heart? |
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Definition
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Term
| Beta Agonists used for preterm labor (3) |
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Definition
| Ritodrine & Terbutaline & Salbutamol |
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Term
| T/F: All beta tocolytics have beta 1 & beta 2 properties |
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Definition
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Term
| Effects of beta 2 receptor stimulation (3 things) |
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Definition
| uterine relations, vasodilation, & glyogenolysis |
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Term
| MOA of Beta Agonist @ uterus |
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Definition
| Beta 2 receptor activation leads to activation of adenyl cycles which makes cAMP which decreases Ca++ & inhibits MLCK leading to uterine relaxation |
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Term
| T/F: You want to d/c a beta agonist before a c-section is begun |
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Definition
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Term
| Main concern for side effects in mother from beta agonist therapy for preterm labor |
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Definition
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Term
| Mechanism of pulmonary edema with beta agonist |
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Definition
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Term
| How do you treat pulmonary edema caused by beta agonist? |
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Definition
corticosteroids
discontinue beta agonist therapy
supplemental o2
fluids restriction (1.2-2.5 L in 24 hours)
Diuretic therapy |
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Term
| T/F: Beta agonist therapy inhibits HPV |
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Definition
| True (leads to worsening of hypoxemia) |
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Term
| Beta 1 stimulation leads to insulin release or glycogenolysis? |
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Definition
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Term
| Why can the patient on beta agonist therapy become hypokalemic? |
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Definition
| Insulin release sends glucose & K+ into cells. Total K+ levels don't change, but less is in the extracellular compartment |
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Term
| Why can patients on beta agonist therapy get hyperkalemic? |
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Definition
| When you stop the beta agonist therapy, you can get rebound hyperkalemia |
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Term
| What other side effects can you get from beta agonist therapy besides hyperkalemia/hypokalemia, hyperglycemia, & pulmonary edema? (4 things) |
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Definition
-elevated serum transaminase
-paralytic ileus
-cerebral vasospasm in patients with previous history of migraine
-respiratory arrest due to increase muscle weakness in patients with MG |
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Term
| T/F: Fetal transfer of beta agonist is very slow. |
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Definition
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Term
| What happens to fetal heart rate in response to beta agonist therapy |
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Definition
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Term
| Neonatal ____________ occurs occurs with beta agonist therapy due to maternal hyperglycemia & hyperinsulinemia |
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Definition
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Term
| Have studies demonstrated any long term fetal effects from beta agonist therapy |
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Definition
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Term
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Definition
| Competitive antagonist for Ca++ at motor end plate. Decreases Ca++ influx into myocyte |
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Term
| Magnesium _______ the release of Ach at the NMJ and the sensitivity of the end plate to Ach |
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Definition
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Term
| T/F: Magnesium has more CV side effects than beta agonist |
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Definition
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Term
| Should you d/c a Mag gtt before you start an epidural? |
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Definition
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Term
| Do Mag increase or decrease the excitability of muscles? |
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Definition
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Term
| T/F: Mag potentiates the action of depolarizing and NDNMB |
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Definition
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Term
| Should you use a defasciulating dose in a hypermagnesmic patient? |
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Definition
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Term
| T/F: You should lower your maintenance dose of NMB in a patient who has been on a Mag gtt |
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Definition
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Term
| T/F: You should lower your intubating dose of NMB in a patient with a Mag get. |
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Definition
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Term
| If you need to relax the uterus during a c-section, what can you do? Name 2 interventions. |
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Definition
| Turn up the gas if its a general. Give nitro or beta agonist if it is a RA |
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Term
| Can you give pitocin IVP? |
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Definition
| No! -- causes severe hypotension that is refractory to treatment |
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