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1. Preterm labor is considered how many weeks?

2. Regular uterine contractions associated with what?

1. Prior to 37 weeks

2. cervical change


Risk Factors for Preterm Labor

1. Multiple gestation*
2. Prior preterm birth*

3. Preterm uterine contractions
4. Premature rupture of membranes
5. Low maternal prepregnancy weight
6. Smoking
7. Substance abuse
8. Short interpregnancy interval
9. Infection (UTI, genital tract, periodontal disease)


PP of Preterm labor? 4

1. Activation of the maternal or fetal hypothalamic-pitutary-adrenal axis due to maternal or fetal stress

2. Deciual-choioamniotic or systemic inflammation caused by infection:

3. Decidual hemorrhage:

4. Pathologic uterine distension:


Pathologic uterine distension can be caused by what?

1. Multiple pregnancy
2. Polyhydramnios
3. Uterine abnormality


Signs & Symptoms of Preterm Labor

1. Menstrual like cramps
2. Low, dull backache
3. Abdominal pressure
4. Pelvic pressure
5. Abdominal cramping with or without diarrhea
6. Increase or change in vaginal discharge (mucous, water, light bloody discharge)
7. Uterine contractions (may be painless)


Evaluation of preterm labor?6

1. Fetal monitoring
2. UA,
3. test for Group B strep,
4. CBC
5. Ultrasound:
6. Amniocentesis:


What would the ultrasound show?

1. Evaluate amount of amniotic fluid
2. Estimate cervical length if


Can determine what? 2

1. Can determine intramniotic infection

2. May be used to determine fetal lung maturity


1. Primary goal?
2. Detection and treatment of the disorder associated with what?
3. Therapy for preterm labor?

1. Primary goal is to delay delivery until fetal maturity is attained

2. Detection and treatment of the disorder associated with preterm labor

3. Therapy for preterm labor


1. Tocolytics are what?

2. What are they? 4

1. Medication to stop preterm labor:

-Calcium channel blockers (nifedipine)
-NSAIDS (indocin)
-B-adrenergic receptor agonists (terbutaline)
-Magnesium sulfate


Contraindications to Tocolyics

1. Advanced labor
2. Mature fetus
3. Severely abnormal fetus or fetal demise
4. Intrauterine infection
5. Significant vaginal bleeding
6. Severe preeclampsia or eclampsia
7. Placental abruption
8. Advanced cervical dilation
9. Fetal compromise
10. Placental insufficiency


1. Why might you give corticosteroids?
2. Maximal benefitif given when?
3. What weeks?
4. Dosing over what period of time?

5. What does it reduce? 3

1. Corticosteroids given to the mother to enhance fetal lung maturity
2. Maximal benefit if given within 7 days of delivery
3. From 24-34 weeks gestation
4. Dosing over 48 hours

5. Reduces:
-Fetal respiratory distress
-Intraventricular hemorrhage
-Necrotizing enterocolitis


Stre[tpcpccis agalactiae
(Group B streptococcus)
1. Genital tract colonization of ______% pregnant women

2. Universal screening for GBS between _____ weeks gestation**

3. If positive administer what?

4. When else would we administer this?

1. 15-40

2. 35-36

3. antibiotic prophylaxis in labor or with premature rupture of membranes

4. OR if pregnant mother has had prior infant with GBS infection*


GBS Antibiotic Prophylaxis
1. Drug?
2. Best if given when?

1. Penicillin G 5 million U IV followed by 2,5-3 million U q 4 hrs. until delivery

2. Best if given 4 hrs. prior to delivery


GBS Antibiotic Prophylaxis
If PCN allergy give what? 3

If PCN allergy then:
1. Cefazolin (If no h/o anaphylaxis to PCN)
2. Or Clindamycin
3. Or Vancomycin


GBS Colonization
1. Treatment prevents what?
2. Prevents what in the mother?
3. May have asymptomatic what?

1. Treatment prevents Group B sepsis of the neonate

2. (In the mother) Prevents postpartum endometritis, sepsis and in rare cases meningitis

3. May have asymptomatic bacturia during pregnancy and that should be treated*


What is the Leading indication for c-section?



1. Dystocia. What is it?

2. AKA?

1. Dystocia—abnormal progression of labor- Defined as lack of progressive cervical dilation of lack of descent of fetal head in birth canal or both

2. Also referred to as “failure to progress”


Evaluation of Labor

1. Is the uterus contracting accurately? (internal monitor)

2. What is the fetal position?

3. Is there indication of cephalopelvic disproportion?

4. What is the fetal status? FHR tracing- want to see accerlations and variability

5. Is there concern for chorioaminonitis?


Progression of Labor
1. Cervix should dilate how much for nulliparous?
2. Multiparous?

3. Fetus should descend at least ____ per hour.

4. Should not be longer than __ hrs. if regional anesthesia

5. Should not be longer that __ hrs. if no anesthesia

6. Second stage arrest is what?

Cervix should dilate:
1. 1 cm/hr in nulliparous
2. 1.5 cm/hr in multiparous

3. Fetus should descend at least 1 cm/hr.

4. 3

5. 2

6. no descent after 1 hr. of pushing


Dystocia Management?

1. Observation

2. Augmentation:

3. Caesarian section (c-section)


Dystocia Management
1. How can we augment? 2

2. When would you do a C section?

-Oxytocin (Pitocin)

-Maternal or fetal distress
-Unstable condition of mother


1. Amniotomy:
- What is it?
-Risks? 2

2. Oxytocin
-Risk? 2

1. Amniotomy:
-Manual rupture of membranes with “hook”
a. fetal heart rate deceleration due to cord compression,
b. increased incidence of chorioamnionitis

2. Oxytocin:
-Pitocin drip per protocol—with increasing amount
-Increases uterine activity (contractions) which in turn should result in cervical change and descent
a. hypertonic uterus,
b. avoid more than 5 contractions in 10 minutes as this can cause decreased blood flow (oxygen) to fetus


Indications for c-section

1. Failure to progress during labor*
2. Nonreassuring fetal status*
3. Fetal malpresentation*

4. Abnormal placentation
5. Maternal infection (HIV, HSV**)
6. Multiple gestation
7. Fetal bleeding diathesis
8. Umbilical cord prolapse
9. Macrosomia
10. Obstruction of birth canal (fibroid, condyloma accuminata, etc)
11. Uterine rupture


Assisted Vaginal Delivery
1. Use when?
2. What can you use? 2

-When mother’s pushing and uterine contractions are insufficient to deliver the infant
-Sudden onset of severe maternal or fetal compromise and mother is fully dilated and effaced

2. Forceps or vacuum extraction


Complications of Assisted Delivery

-Mother? 3
-Baby? 4

-Mother? 1
-Baby? 6

1. perioneal trauma,
2. hematoma,
3. pelvic floor injury

1. injuries to the brain or spine,
2. MSK injury,
3. corneal abrasion,
4. shoulder dystocia in larger infants

-Mother—less maternal trauma than forceps
1. intracranial hemorrhage,
2. subgaleal hematoma,
3. scalp laceration,
4. hyperbilirubinemia,
5. retinal hemorrhage,
6. cephalhematoma


Umbilical cord prolapse:
1. How does it present?

2. Pressure on the cord causes what?

1. Umbilical cord is palpable on vaginal exam, it proceeds the presenting part

2. fetal bradycardia and can eventually cause fetal demise


UCP Management
1. Prompt delivery how?

2. Maneuvers to reduce cord pressure? 4

1. C section

-Examiner’s hand maintained in vagina to elevate presenting part off the cord while arrangement are made for emergency c-section
-Patient is placed in steep trendelenberg position
-Filling the bladder w/ 500-700 ml of NS
-Giving a tocolytic such as terbutaline to stop contractions


Shoulder Dystocia
1. Severity?
2. Defined as?
3. PP?
4. What can precipitate this?

1. Obstetric emergency!

2. Defined as the need for additional obstetric maneuvers to effect delivery of the shoulders at the time of vaginal birth

3. PP: ‏
-If the fetal shoulders remain in an anterior-post position during descent or descend simultaneously the anterior shoulder can become impacted behind the PS

4. Fetal macrosomia can precipitate it


Dangers of Shoulder dystocia include?

1. Entrapement of cord
2. Inability of the child's chest to expand properly?
3. Severe brain damage or death if the child is not delivered in time