Alterations in Labor Onset
Define preterm labor. What are goals of workup?
onset of uterine contractions AND cervical dilation between 20-36 weeks
rule out false labor AND obstetric complications
1. Eclampsia/HELLP Syndrome
2. Shoulder Dystocia
3. Umbilical Cord Prolapse
4. Uterine Rupture
5. Postpartum Hemorrhage
Most problems occur in the immediate postpartum period which is defined as
the first 12 weeks following delivery
Breast milk provides whole nutrition except for which vitamin?
Vitamin D
Thromboembolic disorders- anticoagulation vs IVC filter (LWMH in breastfeeding)
What is fetal fibronectin? If you suspect preterm labor and receive a positive fetal fibronectin result, what does this tell you?
Protein that helps the amniotic sac adhere to the uterus and increases once the sac separates from the placenta
Positive is a nonspecific finding, preterm labor may occur within 7-14 days
What are the first line treatments for shoulder dystocia?
What is the last resort maneuver?
OB Alert- mobilize OR and NICU teams. McRobert's maneuver + suprapubic pressure
Zavanelli- put that thing back where it came from
When should first follow-up be for patients s/p c-section? When should all patients follow-up regardless of c-section or vaginal delivery?
2 weeks; 6 weeks
_______ is released by the _______ pituitary and is responsible for milk production. ________ is released by the _________ pituitary and is responsible for milk release
prolactin; anterior
oxytocin; posterior
What are some of the etiologies of secondary postpartum hemorrhage? When does it occur?
retained placenta, infection, bleeding from placental attachment site
up to 6 weeks postpartum
What is the difference between PROM and PPROM? What would you see on speculum exam?
PROM is the rupture of membranes without associated onset of labor, while PPROM is when this occurs prior to 37 weeks
Would see pooling of fluid in the vaginal canal
Cord prolapse is a clinical diagnosis. What is the most significant finding indicative of cord prolapse?
Sudden, severe, and prolonged fetal bradycardia
Describe uterine involution. What timeline should this occur in?
The process of the uterus returning to normal size. 6-8 weeks
Describe the pathophysiology of lactational amenorrhea
High levels of prolactin inhibit GnRH production which suppresses estrogen and progesterone
What is the #1 priority in postpartum psychosis? What is the treatment?
Safety of mother and infant
Lithium + antipsychotic
If preterm labor is confirmed <34 weeks EGA, what four medication classes should ideally be administered?
Corticosteroids, tocolytics, magnesium sulfate, GBS prohylaxis
What are the four T's of postpartum hemorrhage?
Tone, trauma, tissue, thrombin
What hormones sharply decline after birth? What hormone increases?
progesterone and estrogen decrease
prolactin increases
What is the treatment for candida infection of the breast?
Topical antifungals: miconazole, clotrimazole
What is the treatment for endometritis?
Clindamycin and Gentamycin, add ampicillin w/ concern for GBS
Describe the diagnostic criteria AND treatment for chorioamnionitis
Temp greater than or equal to 102.2 once OR temp 100.4-102.0 and one or more of fetal tachycardia, maternal leukocytosis, purulent cervical discharge
Treatment: deliver the baby, IV antibiotics (ampicillin + gentamycin for vaginal delivery, add metronidazole or clindamycin for c-section)
What are the uterotonic drug and their contraindications?
Oxytocin
Methylgonovine (Methergine)- contraindicated in HTN, preeclampsia
Carboprost (Hemabate)- contraindicated with asthma
the shedding of the decidual layer of the endometrium after birth
rubra- heavy dark bleeding
serosa- light red, pink-brown watery discharge
alba- yellow/white discharge
What antibiotics should be used in mastitis?
Dicloxacillin, cephalexin, Bactrim
What is the mechanism of action of Zuranolone (Zurzuvae)? What is the black box warning?
neuroactive steroid enhancing GABA effects on the brain to promote calm
Black box warning for CNS depression and somnolence