number of pregnancies
live born children
includes gravida and parity
Includes shortening or funneling due to weight of the uterus and developing fetus pushing down.
How to detect cervical insuffieciency
ultrasound at 16 weeks, bed rest may be required.
What is the normal pregnancy gestation?
What is considered preterm?
Less than 37 weeks
Premature rupture of fetal membrane...with hx of premature birth, risk of another premature birth goes up.
Toxic habits in pregnancy
Alcohol, Smoking, Cocaine...all potent teratogens
usually seen among children of women who consume 4-6 drinks/day. Can casue mental retardation, growth restrictions(including the brain), cardiac, spinal and craniofacial anomalies.
decreases available O2 to the fetus and placenta. Lowers birth weight. Higher incidence of PROM and Placenta previa(blockage of the cervix. SIDS
Contains a potent sympathomimetic action, constricts blood vessels. MOM can have MI, CVA, Seizure, bowel ischemia and death. Growth restrictions and PROM..Can cause congenital defects..Limbs, heart, brain and genitourinary tract.
A triad of hypertension, proteinura and generalized edema.
Maternal Hypertension (HTN)
2nd leading cause of maternal mortaility, after embolism. Infant at risk for growth restriction, placental abruption and preterm delivery.
Preeclampsia risk factors
No previous deliveries, older maternal age, chronic HTN
Severe preeclampsia DX
160/110.mmHg, >5g/24hrs of protein, pulmonary edema, fetal growth restriction, oliguria, thrombocytopenia, headache, epigastric or RUQ pain, hepatocellular dysfunction, seizure.
TX of preeclamplsia
Induced delivery and or antihypertensives to mom.
Gestational Diabetes Mellitus GDM
abnormal glucose tolerance that occurs during pregnancy. Mom has increased risk of getting type II diabetes after pregnancy. Increased risk of macrosomia(large baby 4000g), Traumatic vaginal delivery, and possible fetal death(small risk)
Pregestational adverse maternal effects of Diabetes Mellitus?
Diabetic ketoacidosiis, proliferative retinopathy, preeclampsia, eclampsia. Good monitoring decreases risks.
Greatest cause of neonate morbidity and mortality?
Preterm labor, PROM and fetal distress
place suture around cervical canal...bedrest required
Group B Sterptococcus GBS
up to 40% women have this..RX depends on culture...Antibiotic therapy based on sensitivity, (Penicillin or vancoymycin
Herpes..if outbreak during delivery, can infect baby...so C-section ASAP...TX is antivirals, acyclovir, famciclovir and valacyclovir
Hep B and HIV
Screen ALL women for both...RX zidovudin to reduce risk of infection to newborn.also, C-section...Can be transmitted in breast milk.
Greatest cause of neonatal morbidity and mortality
dx of preterm labor
6 contractions in 1 hour with cervical changes
how to stop preterm labor
bedrest, serial cervical exam, oral tocolytics(drugs), IV hydration, Magnesium sulfate, b mimetic agents, indomethacin
Fetal Heart Rate Monitoring FHR
1 external ab transucer 2 ab electrodes 3 fetal scalp monitor
120-160 in utero
greater than 180
FHR>160bpm for <2 minutes (Good fetal response during labor)
FHR drops below 120..Need to watch
FHR dips closely behind contraction.(not a bad thing)
Occur 10-30 sec after contraction...leads to fetal asphyxia
Independent of contractions...(may or may not be bad)
effective in delaying delivery for 48 hours
Glucocorticoids(bethamethasone and dexamethasone)
Given to women 24-34 weeks with preterm labor...stops production of type II surfactant cells, reduces RDS, Decreases Intracranial Hemorrhage
Terbutaline and ritodrine...causes uterine relaxation
Postterm pregnancy (>40 weeks)causes:
Miscalculation of due date, anencephaly, placental sulfatase deficiency, abdominal pregnancy..causes maternal anxiety, oligohydramnios, macrosomnia and meconium aspiration syndrome
Meconium aspiration syndrome
Passage of fecal from fetus into amniotic fluid, and into the baby lungs...Occurs after 42 weeks, associated with fetal hypoxia, results in AW obstruction and inflammatory reaction in the lungs
Postterm preg. baby may have
oligohydramnios, macrosomia and placental insuffiecieny, meconium aspiration syndrome
How to prevent postterm pregnancy?
induce labor after 41 wks
Prenatal care should include?
Ultrasound, amniocentesis(L/S ratio, alpha-fetoprotein, shake/foam test), Fetal biophysical profile and non-stress test.
Legs or butt first
Lecithin/spingomyelin L/S ratio
should be 2:1 or greater to indicate lung maturity. if less than 1.5:1, infant at risk
commonly performed. Needle, uterus to get sample of amniotic fluid. Can analyze Surfactant, Bilirubin, Trisomy21(down syndrome), L/S Ratio
Shake foam test..
mix amniotic fluid with alcohol and saline. Shake for 15 sec and wait 15 minutes. Should form bubbles (surfactant)
Cesarean Delivery Risks
Bleeding, Infection, Anethesia complications, Bladder or bowel injury, Endomyometritis, Thrombombolic events
Transient tachypnea of newborn
Cyanosis, grunting, and tachypnea in first few hours. Due to lung fluid not being expelled or absorbed.
Normal length of umbilical cord
55cm. Short cord increases risk of placental abruption...long cord associated with cord prolapse, or delivery of cord before the infant. This comprimises blood flow doe to compression. Cord knots
Cord wrapped around infant's neck.
When placenta grows in lowest part of the womb.
placenta separates from the uterus.
#1 cause of maternal mortality
Maternal Hypertension is #2