Maternity Exam 3 (new study guide)
Questions And Answers, New Update
2023
Recognize the risk factors for preterm labor and common symptoms reported. -
... [Show More] Correct
Answer-o Hx of preterm birth or infection** (infection is only definitive cause*: UTI, STI
etc..)
o -50% have no risk factor*** and occur in any births
o -Preterm birth associated with increased infant morbidity and mortality: the earlier they
are, the worse it gets.
-Teach all women signs of PTL**
-s/s: Increased vaginal D/C, pelvic pressure, low backache, cramping, leaking fluid,
feels like baby is "balling up"******
o -late PNC, AA race, multiple gestation, polyhydramnios, bleeding, infection, low
progesterone, underweight, smoking/drugs, stress, dental
Identify the fetal benefits of betamethasone and magnesium sulfate during preterm
labor. - Correct Answer--magnesium sulfate:
-< 32 weeks MgSO4 neuro- protection for cerebral palsy **
- Mag Sulfate can be used for neuroprotection (increases brain perfusion and decreases
cell death; prevents CP) between 24-32 weeks
-betamethasone: Lung maturity* - IM injections of steroid (betamethasone)* given to
mother to stimulate fetal surfactant production
-Reduces respiratory distress, brain bleeds, NEC, and death in infants
-Given between 24-34 (may go up to 37) weeks in two doses 12-24 hrs apart.
-SE: Corticosteroids will raise blood glucose*. Diabetic with previously well controlled
blood sugars may require an increase insulin dosage for several days**
Review the fetal response to maternal terbutaline administration. - Correct Answer--
Terbutaline - Short term use (< 24 hrs). Given sub-q. Beta-adrenergic agonist = relaxes
smooth muscle. May be used to delay ctx to get pt to tertiary care center
-May be given for tachysystole during induction or augmentation
-SE: Tachycardia (common), jitteriness, chest pain, arrhythmias, fetal tachycardia**
Know the maternal side effects and precautions/contraindications for commonly used
medications: terbutaline, magnesium sulfate, nifedipine, and indomethacin. - Correct
Answer--Tocolytics - Medications to stop contractions/uterine activity
-All US tocolytics are off-label use* (FDA approved for something else, like asthma or
HTN)
o Mag Sulfate - Given IV. Depresses nervous system and relaxes smooth muscle
(uterus). Frequently used but not supported by literature*
-Severe SE: Decreased RR (<12), absent DTRs, altered LOC, decreased UO (<
30ml/hr or 100ml/4hr), pulmonary edema***
o Terbutaline - Short term use (< 24 hrs). Given sub-q. Beta-adrenergic agonist =
relaxes smooth muscle. May be used to delay ctx to get pt to tertiary care center
-May be given for tachysystole during induction or augmentation
-SE: Tachycardia (common), jitteriness, chest pain, arrhythmias, fetal tachycardia**
-Nifedipine - Given PO. Calcium channel blocker (need calcium in cells for muscle ctx). -
Fewer side effects than previous two. Also used in PIH.
-SE: Hypotension, headache, dizziness, nausea
-Contraindicated if hypotensive***
o Indomethacin - NSAID. Blocks prostaglandins. Can have serious fetal side effects.
Used rarely - only for a couple days and only less than 32 weeks**
-SE: Constricts ductus arteriosus, oligohydramnios r/t decreased urine output, neonatal
pulmonary HTN, GI bleeding (mom), N/V (mom)
o Lung maturity - IM injections of steroid (betamethasone*) given to mother to stimulate
fetal surfactant production
• Reduces respiratory distress, brain bleeds, NEC, and death in infants
• Given between 24-34 (may go up to 37) weeks in two doses 12-24 hrs apart.
• SE: Corticosteroids will raise blood glucose*. Diabetic with previously well controlled
blood sugars may require an increase insulin dosage for several days*.
-Inevitable PTB - Mag Sulfate can also be used for neuroprotection* (increases brain
perfusion and decreases cell death; prevents CP*) between 24-32 weeks
Understand the commonalities and differences between pPROM and PROM. - Correct
Answer-o Prelabor Rupture of Membranes (PROM): Membranes rupture >1 hr prior to
onset of contractions
(at any gestational age)**
-Risk of infection if pregnancy continued
• Expectant vs active management
• If term - likely induction of labor
• Minimize vaginal exams
• Antibiotics if GBS+, fever, or
18-24 hrs duration PROM
o Preterm Prelabor Rupture of Membranes (pPROM): Membrane rupture >1 hr before
labor AND less than 37 weeks gestation*
Neonatal vs infection risks
• Conservative management
• > 34 weeks: amnio for lung maturity
• < 34 weeks: delay birth
Antibiotics & steroids given
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