Mom/Baby

• Hydrate. 
• Could be cramping due to dehydration. 
• Can also ambulate, distract, rest, etc.
• Rx is last resort. 

• Platypelloid/android pelvis
• FUPA
• HPV/Genital warts
• Any other fleshy obstruction to the vaginal canal. 

• size
• anomalies
• CPD
• Multiple feti (twins, trips, God forbid quads)
• Malposition
• Malpresentation

• Prolapsed cord.
• Admin O2.
• Get baby out quickly! May mean shoving head back in and running to OR.

• Drop bed to Trundelburg's
• place Mom in McBob's postion: knees bent and shoved way up towards chest. Hopefully this will roll pelvis bone over shoulder.
• Can also apply suprapubic pressure to rotate shoulder medially to tuck it under the pupic bone.
• May also break collar bone to deliver. Will reset very quickly after birth but will leave a lump in the bone. 

• Painless vaginal bleeding, usually ~34ks.
• may also present with contractions. 
• NEVER do a SVE on pt with previa and/or vaginal bleeding!!!

IV Nitroglycerine

• Artificial rupture of fetal membrane (SOW)
• To induce labor
• augment labor
• apply an internal FSE
• IUPC
• Obtain a fetal scalp blood sample

• Prevent variable decels
• Treat variable deels
• *Will not be effective if goal is to dilute meconium stained amniotic fluid. 

• Maternal:
• Hear disease
• Acute pulomanary edema
• intrapartial infection
• prolonged 2nd stage
• Exhaustion (mom simply is incapable of more pushing.
• Fetal:
• premature placental separation (abruptio placentae!)
• Non-reassuring fetal status)

• Airway
• tachycardia
• hypotension

• Famotadine: H2 receptor antagonist. Inhibits gastric secretions. Used prophylactically to prevent stomach content aspiration during c/s.
• Regalan: Dopamine antagonist. Antiemetic used during c/s and prophylactically for postop. 
• Bicitra: Reduces stomach pH. 

• One previous c/s birht and low transverse uterine incision
• adequate pelvis
• no other uterine scars or pervious uterine rupture
• avaliable dr who can do c/s
• in-house anesthesia personnel. 

• prolonge dlabor
• macrosomia
• oxytocin augmentation
• grandmultiparity
• anesthesia/drugs
• intra-amniotic infection
• chroiamnionitis
• asian/hispanic 
• c/s
• retained placenta
• placenta previa
• multiple gestation
• hydramnios
• tocolytics

• 1st line pph.
• Must dilute in 1000mL LR
• Prolonged admin-->antidiuretic and water toxicity

• Ergot derivitive
• Vasoconstrictor
• CX for HTN
• Do not admin IV to v risk of sudden HTN

• Cx for cardiac, renal, or pulmonary dysfnxn.
• Do not admin IV
• 2000mcg max

• Prostoglandin
• Few side effects
• Most commonly admin'd PR (rectal)

• Prostoglandin
• Either vaginal or rectal admin

• Typically present with peri pain
• Rectal pressure if in posterior vaginal area
• Diff urinating if in upper part of vagina
• Pelvic pain if subperitoneal hematoma
• All may-->shock if unidentified

• Pervious incision
• Tachysystole or hypertonus
• Trauma

• Severe abd pain
• Changing uterine tone
• fetal bradycardia
• fetal station may suddenly change
• Maternal n/v
• maternal syncope
• vaginal bleeding
• Referred pain (possibly to shoulder)
• maternal tachycardia and hypotension
• palpation of fetus through  abd wall. 

• placenta previa 
• c/s

• Subinvolution
• --fundus remains high
• --lochia fails to progress from rubra to serosa to alba
• --usually because of retained placenta
• --Tx with Methergine ~1wk.
• Retained placental fragment
• --D & C (debridement and curatage). 

• Sleeplessness/jitteriness
• Poor suck
• Inconsolable crying
• Hyperactive w/ little interest in environment
• abd dinstension
• seizures

• seizures/hallucinations
• pulmonary edema
• resp failure
• cardica problems
• spontaneous abortion, abruptio placentae (biggest) IUGR, pretuern birth, stillbirth

• v birth weight and head circumference
• diff feeding
• if in breast milk
• --extreme irritability
• --v/d
• --dilated pupils
• --apnea

Diabetic ketoacidocis

HPL-->v insulin sensitivity in mom, so-->^ demand of insulin supply to x2-x4 pregrenancy needs. 

• screen at 24-28 weeks, earlier if high risk
• 50gm glucose test
• --random
• --non-fasting
• --draw blood in 1hr during which no eating, exercise, or smoking
• >135-->risk for GDM

• 3 hr GTT with 2/4 results elevated
• Done via overnight fast followed by 100gm glucose drink.
• Draw blood at 0,1, 2, and 3 hr.

• Macrosomia
• x2 risk preeclempsia
• RDS from delayed pulmonary maturation
• hypoglycemai within 1hr birth
• IUGR

• congenital heart anomolies
• polyhydramnios
• IUGR
• ^nfxn
• pernatal loss, anomalies, and sudden unexplained stillbirth

• establish good control before attempting conception because...
• --x5 risk of heart and CNS anomolies
• Help mom anticipate normal elevated insulin demands during pregnancy
• HgbA1c is good indication of control
• ADA diet
• Nutrition, rational, and home monitoring
• Suppliment with insulin if not entirely diet controlled
• Monitor fetus with NST and ultrasound
• PG more reliable than L:S ratio for determining fetal lung maturity

• has an antidiabetic effect
• lowers insulin needs to 1/2 of prepregnancy levels
• v baby's risk of becoming diabetic

• >140/90
• Present before pregnancy or up to 20 weeks gestation
• ^risk of developing pre/eclampsia

• abruptio placentae
• pulmonary edema after delivery
• renal failure
• hypertensive encephalopathy

Methyldopa.

• F
• Virus passes in breastmilk

• ^ viral load
• chorioamnionitis
• ROM>4hrs prebirth
• Prematurity
• breastfeeding
• **always test neonate at least 6mo after birth. Will always test positive before 6mo. 

• hemorrhage
• pp nfxn
• v wound healing
• nfxn of genitourinary tract

• premature
• SGA
• v birth weight

• standard precautions
• antiretrovirals first 6wks
• routine vaccines, but no OPV, MMR, or Varicella because they are live viruses.
• No family members should get these either. 

• Toxic build up of phenylalanine
• teratogenic-->microcephaly, mental retardation, cardiac defects
• Mom must be on strick diet BEFORE and THROUGHOUT conception. Not much use to start diet afterward.
• Subtle neuro, behavioral, and IQ effects if diet discontinued after age 6.