- adequate education/prenatal care, FHR, uterine contraction monitoring, Bedrest, hydration, sedation Tocolytics- anti-contraction or labor suppressants (Not given > 34 Weeks) To delay labor by 48 hours so steroids can reach maximal effects 1) Indomethacin (NSAID)- Prostaglandin (Most common tocolytic) 24-32 Weeks of Gestation S.E.- GI Bleed, nausea No > 72 hours 2) Nifedipine (CCB)- 24-32 Weeks 32-34 Weeks- Nifedipine is #1 3) Terbutaline (b2 agonist)- 32-34 Weeks IV- Mag sulfate or B-agonists (terbutaline, ritodrine) Oral once contractions stop
Subcutaneous terbutaline for long-term maintenance Corticosteroids (betamethasone, dexa)- accelerate fetal lung maturation Deliver if- maternal/fetal instability First Trimester Bleeding 1:4 Experience (vary from light to heavy w/clots) Spontaneous Abortion (Miscarriage) Common Dx. 15-20% lost; Most in 1 st trimester due to chromosomal abnormalities Bleeding pink, red (fresh), Brown (old) Classification Induced- medical/elective Threatened- vaginal bleeding < 20 weeks w/out dilation Still viable pregnancy Inevitable- bleeding or ROM w/ dilation Incomplete- expulsion of some products Complete- expulsion of all products Missed- Undetected death of an embryo or a fetus that is not expelled No bleeding- Nonviable on US Transvaginal US should be done and if lost most do not require intervention Causes Ectopic- 1.9% of pregnancies, leading cause of 1 st trimester maternal death RF- tubal damage, prior EP, PID/STI History, previous tubal ligation Molar- also 1 st trimester, severe N&V, Hyperthyroid Sx (nervous/tired, fast/irreg. HR, sweat) PE- Uterus larger than normal; Labs= hCG; Absent FHT; US= grape-like clusters Placenta Previa- painless bright red vaginal 2 nd trimester bleeding Types- Complete, Partial, Marginal Vaginal Bleeding most likely in 3 rd trimester Abruptio Placenta- premature separation of placenta from uterus 3 rd Trimester bleeding, uterine cx and fetal distress; Hemorrhaging Pregnancy Induced Hypertension (Gestational HTN) BP > 140/90 x 2 occasions at least 6 hours apart no >7 days apart Or rise > 30/15 Risk- DM, CKD, HTN, <15 or >35 Labs- CBC, CMP (w/ LFT) Management- fetal surveillance, kick counts, NST, left side-lying rest Rx- Pre-Eclampsia PIH + Proteinuria (w/o UTI; 2 specimens > 300 in 24 hours) Weight Gain- too much is >2 lbs./week or ≥ 6 pounds in 1 month AA Primigravidas- 15-20%, while young Primigravidas w/ twins 30% Risk - Primigravida, family/personal history, adolescence of SES, >35, multiple gestation
Polyhydramnios, malnutrition, pre-existing HTN/Renal, Hydatidiform mole Rh Incompatibility, DM Nulliparity not a risk factor for HELLP Diagnostics - BP > 140/90 on 2 occasions at least 6 hours apart, no > 7 days apart Excretion of > 300 of protein over 24 hours; dipstick of 1+ or greater (30mg/dL) End Organ Damage, In lieu of Proteinuria Assess for 1+ edema, but not a criterion anymore Assessment - HTN/Tachycardia, Hyperreflexia (> 3-4+) , Fundal Height Weight Gain > 2 lb./week or 6 lb. in 1 month Oliguria/Anuria, Proteinuria, hematuria, edema Dizziness/ SEVERE HA; Blurred vision/diplopia, Scotoma, Retinal Edema Dyspnea/Crackles; Epigastric pain, Hepatomegaly
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- Summer '17