toxoplasmosis, cytomegalovirus, herpes, and rubella; preterm birth can occur as a result; a woman may present with SOB because of extra pressure on her diaphragm from the large uterus; Tx=amniocentesis Premature rupture of membranes :  Previous preterm labor and previous premature ROM are both significant risk factors for premature ROM. Cervicitis, amniocentesis, and placenta previa are all less significant risk factors for preterm premature ROM. Nulliparous women who work outside the home are thought to be at increased risk of preterm premature rupture of membranes.  Nitrazine test—nitrazine paper test relies on the fact that amniotic fluid is more alkaline than normal vaginal secretions; a color change in the paper to blue-green or blue is highly indicative of ROM Drugs used in premature labor :  Betamethasone-administered to enhance fetal lung maturity  Magnesium sulfate—used to halt premature labor; can cause many adverse rxns  Nifedipine—a calcium channel blocker that can be used to halt premature labor; can cause maternal adverse rxns  Ritodrine hydrochloride—used to halt premature labor; can cause maternal adverse rxns

Catherine and Brooke’s awesome OB study guide 33 Readings from Ch. 27 Care of the Woman and Fetus at Risk for Precipitous Labor and Birth (to include) Risks of precipitous labor and birth Care of the Woman with Post-term Pregnancy (to include all sub-headings) Care of the Woman and Fetus at Risk Because of Fetal Malposition (to include all sub-headings) Care of the woman and Fetus at Risk Because of Fetal Malpresentation (to include) Breech presentation Shoulder presentation Care of the Woman and Fetus at Risk Because of Macrosomia Care of the woman Experiencing Placental and Umbilical Cord Problems (to include) Placental problems Care of the Woman and Fetus with a Prolapsed Umbilical Cord (to include) Maternal-Fetal-Neonatal risks Care of the woman with a Uterine Rupture Care of the woman at Risk Because of Complications of 3 rd and 4 th Stages of Labor (to include) Placenta accreta Chapter 27 – Childbirth at Risk: Labor-Related Complications A. Areas of concern for labor-related complications a. Mom – i. Precipitous (fast, quick) labor and birth 1. Labor that lasts less than 3 hours 2. Not the same as precipitous delivery 3. Risks – Mom – uterine rupture, lacerations, decreased coping 4. Risks – Baby – distress, cerebral trauma 5. Family history, not the first baby, large pelvis and small baby – these tend to lead to precipitous labor 6. What to do? Can use med to slow down labor, magnesium can slow down labor, but don’t usually have time to give meds; monitor mom and baby closely, want as much of a controlled birth as possible; is stressful for the mom ii. Post-term pregnancy 1. Pregnancy >294 days or 42 weeks past 1 st day of LMP 2. 40 weeks gestation – placenta can calcify (harden)

Catherine and Brooke’s awesome OB study guide 34 3. Can do non-stress test a. If non-reactive, then send her for BPP 4. Mom can monitor kick counts if sent home 5. Risks – Mom – stressful a. Baby – placenta, fluid (decreased amount of amniotic fluid is