Complications of Labor and Delivery question n answers graded A+

Complications of Labor and Delivery Preterm labor - correct answer This is *uterine contractions w/ or w/o cervical dilation prior to 37wks* Risk: - smoking - previous premature delivery - vaginal bleeding during pregnancy Etiology: - preterm premature rupture of fetal membranes leads to preterm delivery - infections caused by prostaglandin endotoxin producing bacteria ( strep, gardnerella vaginalis) - Dehydration, lack of amniotic fluid - Incompetent cervix - excessive uterine enlargement ( twins or high order multiples) - uterine trauma - placental abnormalities ( placenta previa) - substance abuse (cocaine) -advanced maternal age - Pt. w/ *1st trimester bleeding ( @ risk for threatened abortion)* Clinical manifestations: o Regular uterine contractions between 20-35 wks gestation, 5-8 min apart or less w/ 1 or more of the following signs: - Change in cervix: soft - Cervical dilation: > 2cm ( women is in labor when cervix dilated >4cm) - Cervical effacement: > 80% - also may include painful or painless contractions, pressure, menstrual like cramps, watery or bloody discharge, and lower back pain Dx. - *ultrasound for cervical length*: should be 4cm long ( if not a sign of effacement) - *Nitrazine testing*: to distinguishes amniotic fluid (pH > 7) from urine and vaginal fluid - * Ferning*:distinguishes amniotic fluid from other fluids due to NaCl content in amniotic fluid - *Fubronectin protein*: 99% accurate if absent for no premature labor in the next 2wks -> *GLYCOPROTEIN*: marker for premature labor w/in next 2wks o It is the biological glue attaching fetal sac to uterine lining o Found prior to 22wks and in last part of 3rd trimester - *SalEst: lvl of estriol in saliva that increases* 2-3wks prior to *spontaneous labor and delivery* Management: o bed rest o hydration o IV or ringer lacters or normal saline o *Tocolytics*: suppress contracti Premature rupture of membranes - correct answer This is *rupture of chorioamniotic amniotic membranes before onset of labor at or beyond 37wks gestation.* -> Most women proceed to spontaneous labor Risk: - increased if smoking during pregnancy - short cervical length - prior preterm delivery - multiple gestation, bleeding early in pregnancy