Brethine Firm Labor Law Preterm

Brethine Firm Labor Law Preterm

no epilepsy) -Tx—Mg sulfate -Chronic HTN— -present 100 -tachy mom and or baby -uterine tenderness -cervical d/c -25-30% will have +AF culture(means there’s bacteria growing in chorion(baby septic and maybe die *keep vaginal exams to a minimum -Other problems with PROM— -Cord Prolapse— -baby not in pelvis yet -water breaks(cord goes in front of head(pressure on cord(no O2 to baby(DELIVER -Placenta Abruptio—higher incidence with PROM -increased C-section rate with PROM -Amnionic Band Syndrome— -fetal parts get entangled in amnionic membrane—stick -deformity, growth restriction, amputation Managing PROM— -educate moms for signs -look for leaking -hospitalize when breaks -expectant management—can sometimes seal over -inner layer may be in tact—keep fluid in -if no infx and baby OK(do expectant mgt -sterile spec -cultures—gonorrhea and chlamydia and group B strep -in labor(vaginal exam—wait until then, review prenatal records and know for sure gestational age -if infx or + culture( -antibiotics to mom -baby needs to be born -in utero is too hostile(OUT -assess fetal lung maturity—molecules from AF—get sample 1.

miscarriage and no follow up(hcG is still up but don’t know it -rapid and invasive, rare but virulent *get D&C to protect—no more tissue left to originate from if miscarry in 1st 8-12 weeks(90% of the time it is b/c of a chromosomal abnormality -nothing the mom did—couldn’t stop it -usu “get over” it after babys due date -acknowledge the pg—don’t discount it -if they wanted it—sad -if they had mixed feelings—guilty -RF for spontaneous abortions— -high parody -increased maternal age (35-40—7 fold increase) -increased paternal age -conception within 3 mo of birth -2nd trimester and after miscarry(reasons— -maternal infx, viral, STDs, endocrine (DM, HTN, thyroid d/o), decreased production of progesterone -early on—the corpus luteum makes the progesterone(16 weeks—placenta takes over(if there is a lag time(there is a decreased level of progesterone(miscarry -spontaneous abortion(smoking (1 pack/day—2 fold increase, a walk on the moon diane lane etoh) -uterine factors of spontaneous abortion/miscarriage— -leiomyomas -bicorneate uterus—2 horns -separation in the middle -Asherman’s Syndrome— -scarring where D&C went to deep(if placenta implants there it will ba an abnormal implantation 2 consecutive or a total of 3 spontaneous abortions(look into the previous list for a reason -e. Herpes—DNA virus -HSVI—oral -HSVII—genital -can cross over -genital skin is infected by virus(lumbosacral dorsal roots(infects ganglia -becomes read the bible in a year schedule a persistent subclinical infx -becomes active on stress, immunocompromised, cycles, etc -incubation period—1-30d -main complaint(very painful blisters/ulcers -has a prodrome -primary infx—may have systemic sx—infx, malaise, lymphadenopathy -can lead to herpes meningitis or encephalitis(death -lesion is a vesicle(goes to ulcer with red boarder(crusts over -primary outbreak—2-3weeks to heal -recurrent infx—less severe—7-10d to heel -triggered by stress menses, sex, or no reason -culture—swab the lesions—results in 48h -Tx( -acyclovir—primary outbreak—200mg x 5xd for 7-10d -recurrent infx(same but only use for 5d -daily suppressant therapy—good in pg—400mg bid -if very severe infx(may need hospitalization with acyclovir IV (for meningitis too) -any creams to help the sore -be careful when diagnosing monogamous female with cheating husband PID— -chlamydia and gonorrhea -start as STDs(can spread and cause PID -chlamydia—obligate intracellular parasite—can cause( -cervicitis -salpingitis -perihepatitis—Fitz-Few-Curtis Syndrome—get adhesions around anterior liver—RUQ pain -urethritis—males too -can be asymptomatic or have purulent d/c -dysuria and frequency common too -PE( -cervix may look normal or red -very friable on contact—bleeds easily -Culture( -Genprobe(cotton swab in cervical canal for 20s(then put in transport medium(lab -Tx( -Zithromax 1g dose—OK in pg -OR— -doxycycline(100mg bid x 7d -Tx the partner -if pg(reculture in 3-4 weeks (major cause of preterm labor) -chlamydia is very insiduous(feel shitty for long time -gonorrhea (the clap)— -incubation period—2-8d -Sx( -vaginal d/c -frequency and dysuria -menstrual irregularities -bilateral lower abd pain -no sx(asymptomatic carrier -can get in vagina, oral/pharynx, and rectum -can spread hematogenously( -lead to sepsis -usu affects one big joint -can have skin lesions(anywhere on skin—will be necrotic in the center -can spread locally(PID -PE( -PURULENT d/c from vagina/penis -bartholin’s or skenes glands may be swollen -fever (in acute PID) -adnexal and abd tenderness -culture and gram stain d/c -Long term(can develop into tubalovarian absess -Long term affects of chlamydia and gonorrhea( -STREILITY -Tx—uncomplicated( -Rocephin IM x 1—125mg—and doxycycline for a week -Cipro—500mg PO and doxycycline 100mg bid -Azithromycin—300mg qid x 1week (use if allergic) -Re-culture after tx (1-2 months)—if there is a re-infx or it never cleared up -PID—if it develops within 1 week p mentrual cycle -gonorrhea(acute -chlamydia(insiduous Syphilis—anaerobic spirochete—troponema pellidum -incubation—2-6 weeks -3 stages( 1. pg test— -urine test—most common—detects HcG 4 weeks after LMP -low FP but high FN -serum—more sensitive—need a quantitative HcG -get a number that correlates with how many weeks pg she is -can follow HcG levels if problematic to distinguish b/t nl and abnl pg -HcG doubles q2d until 10weeks then it levels out -progesterone—can also be measured -25ng/mL(viable intrauterine pg 2.

4 contractions in 2 hours, should zodiac sign and their meaning I take a brethine pill?Resolved Question 4 contractions in 2 hours, should I take a brethine pill? I'm 31. The following health oriented websites are recommended: The following on-site destinations recommended: Site Tree DisclaimerLink Index Resources More Resources.
fetoscope—18 weeks until you hear it—more specific for the sounds and positions and locations of things 2. reach fingers in and see if the cord is there—if tight—cut ot or loosen it -on the next contraction(there will be an external rotation by the baby—head will turn to get in alignment with the shoulders—best way to come out is AP -anterior shoulder comes out first -posterior shoulder next -down then up -baby will be very slippery and cute -usually will breathe spontaneously -when the squeeze from the vagina is gone the pressure decreases(inhalation NEXT— -towel to keep warm -give baby to mom (unless something is wrong) -don’t drop the baby (probably on the exam) -keep warm—loses heat quickly -no rush to cut the cord (again, as long as nothing wrong) 3. detailed fertility executive leather office chair hx— -ever pg(outcome 4. PO Contraceptives— -most common -monophasic are better then triphasic -can make psychological sx worse -help physical sx 2. presenting complaint—pain, nodule, etc 2.

doppler—most common -jelly, type of ultrasound—mom hears it too 5. neurosyphilis—CNS and cardiovascular changes -may be years later -gumma(nodular, ulcerative lesions—anywhere -Lab Tests( -BDRL or UDRL -RPR—rapid plasma reagent -will be + 1-2 weeks after primary syphilis -FP—infx mono and collagen vascular dzs (need to r/o) -Tx( -PCN—2. Terbutaline, New York Pharmaceutical Litigation Lawyer, NY Personal Injury Attorney, Dangerous Drugs Terbutaline Sulfate, sold under the brand names Brethine and Bricanyl, is an asthma medication that has come to be used on an "off-label" basis to treat preterm labor. Laminarea— -wick into cervix -absorb fluids(dilates(pushes cervix apart -not used(increased rate of infx Augmentation— -labor already started—make it stronger/faster 1.

psychiatric problem—severe PMS—emotional sx *very severe PMS is(Late Luteal Phase Dysphoric D/O 8. size of baby— -palpation -ultrasound—can girl scout of lake erie council be off by 500-1000g 2. sexual hx— -frequency -dyspareunia -etc 8.

partial PP—placenta partially covers os iii.
intramural causes— -fibroid tumors in wall -adenomyosis—like endo but the endo lining is deeper into the planned parenthood san jose muscle of the uterus 3.

6 units insulin/Kg = total for the day -divide that number up to 2/3 AM and 1/3 PM -further divide each dose into— 2/3 NPH (long lasting) 1/3 regular 3. inhibit hormones— -inhibit ovulation 2.

PG—phosphatidle glycerol -if present(lungs mature -Used to do routine C-section, forceps, large episiotomy in any PROM—we though it protectd the head -now we allow vaginal delivery—slow and controlled -may or may not cut episiotomy -Check color of AF— -brown—old meconium—days -pee soup—new meconium(baby is in acute distress -should be clear—some white vernix floating in it—OK Pre-Term Labor— -most common cause of perinatal morbidity and mortality -regular uterine contractions q 10min or less, b/t 20 and 36 weeks gestation accompanied by cervical dilation and effacement and or descent of the fetus into pelvis -remember—if this happens 20weeks(it’s a spontaneous abortion -prematurity is based on gestational age NOT BW -low BW25mmHg -50-60 is optimal -toco will sometimes not work(listen to the mom -intrauterine cath—believe the cath—very accurate -1st stage—dilitation phase— -latent—0-4cm -can go days of starting and stopping—not an arrest of labor -active—4+cm -if it stops for at least a few hours here(dystocia -2nd stage—expulsion— -power—uterus contracts and mom bears down -uterus will expell the kid even if mom doesn’t bear down but takes a lot longer -interferances with power of contractions— -anxiety—increased symp NS -anesthesia—1st or 2nd stage -two types— -IV—stadol (barb) -lasts 1h -takes edge off pain—sleep b/t contractions -Epidural—injected into epi sapce -works in 1 of 2 ways -relax mom to stop fighting labor -blocks symp NS**?para takes over and dilates -in 2nd stage(need symp NS(if on epidural(have to push an extra hour to get it out -use whole body to push— -not flat on back -grab knees—curl spine into a C -work with the contractions—should get 3 good pushes during a contraction Passenger—4 variables— 1. pitocin—IV—watch heart tones(can get fetal distress (this is the main risk of pitocin use) -late decels(uteroplacental insufficiency -Tx—turn pitocin off 2.
vulvar— -varicose vein rupture -tear / lac—high index of suspicion for abuse 2. team work—make sure she gets all aspect of what she needs 4. increase in fluid retention—no increase in weight but there are alterations in the renin-angiotensin-aldosterone axis -also alterations in ADH 10. mechanical or chemical barriers— -condom, spermicides, etc 3.
Retained Placenta— -none let go -worse is partially separated * if its not uterine atony(look at placenta and make sure all there -risks— -previous c-section -fibroid -low lying placenta (type of previa) -succinturiate lobe—satellite to the placenta gets left inside -2 ways to get chunks of the placenta out— -manual removal- -do with active bleeding -sweep out with hand and guaze -orange in sock—peel it -give mom demeraol/stadol to relax -D&C if manual didn’t work Abnormally implanted placenta— -placenta accreta—attached to lining -placenta increta—into muscle -placenta percreta—all the way thru the uterine muscle thickness -hysterectomy is the only cure for these -Other Causes of PP Hemorrhage— -coagulation defect—DIC (most common of the rare)—spill blood on floor and move it with foot and see if it coags -can get from increased blood loss, preeclampsia, abruptio, fetal dimise -hematoma—may not see -pain and shocky -usu in vaginal wall/vulva -can occur with no lac or at site of episiotomy 5cm—or if its getting bigger or shock(need surgery I&D -Amniotic fluid embolism— -pushed thru placental circ into moms circ -mortality in 90%s -sudden CV collapse—just like DIC -Uterine Inversion— -wrong side out -someone pulled on cord before it was ready -give anesthesia and put it back in OB Procedures— 1. gyn hx— -PID -other STDs -surgeries 7.
MRI—magnetic resonance imaging -better for brain and bones -same uses as CT 4.

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Tylenol Category B—most of them -presumed safety based on animal studies -not 100% Category C—uncertain safety -animal show adverse effects -e. missed abortion / blighted ovum— -fetus died but not expelled -ultrasound—discrepency b/t gestational sac and where it should be for that time -measure and follow hcG -can wait for mom to expell on own if she wants (1 week)—but increased chance of infx and rare but serious complication is DIC -choriocarcinoma—invasive CA -from left behind placental tissue -kills young women -e. Prgesterone— -stimulate 5-HT activity -natural is better than synthetic -doses vary depending on pg or not (ever) -has been pg(200-400 bid of natural progesterone -never pg(100-200 bid—natural 3. nipple stimulation -want it to be negative -if positive(abnl(means theres been repetetive deccelerations -3 contractions in 10min(if all 3 show decrease in HR(positive test(need to deliver Chapter 19— Fetal Growth Abnormalities— IUGR (restriction)—Biggest problem— -fetal weight is in lowest 10%ile of nl (based on nl weight for specific gestational age) -increase perinatal mortality rate 7-10x 2 kinds— 1.
qualitative amnionic fluid volume -AFI 5 = oligohydramnios -AFI 5-8 = boarder -AFI 8+ = Nl Scores— 8-10 = nl 6 = equivical—repeat in 24h—if same(problem 4 = problem 3. The use of Terbutaline for this purpose is not an approved use by the Food and Drug Administration ("FDA").
states that the drug should not table saw rip fence be used for management of preterm Supporting the reasons for not using Terbutaline to manage preterm labor, studies have revealed a link between the use of terbutaline during pregnancy and an increased risk of brain damage and cognitive deficits.

episiotomy—rip is better—heals better for next delivery 6/6/00 APGAR score—(Virginia) 5 characteristics— -do at 1, 5, 10 minutes -somewhat subjective 012HRNone100Muscle toneCompletely limpLittle floppyActive / hold selfResp effortNo effortNot working very hardTrying beautiful woman in the world to breathReflex activityNoneGrimmacesCough sneeze, cry on suctionColorEntire body blue, purple, paleBody pink, extremities bluepinkScores— 7-10—healthy, no active distress—rub back and keep warm 4-7—mild-moderate distress—may need— -deeper suction -PEEP -tactile stim -O2 week after d/c is gone -should wait 6 weeks -no tampons if d/c -Breast feeding— -primary function -prenatal preperation— -inverted nipples—pull out 1x/d and rub -find comfortable position -nipple goes up on baby’s palate—tongue to get milk -as much aereola in mouth as possible—or else more sore -no schedule—q1. drugs—male and female— -many decrease fertility -tranqulizers, antihypertensives, marijuana Ovulation Detection— -recover an ovum from the reproductive tract—only way to definitively show -regular menses—21-35d long -ovulatory sx—mittleshmirtz, changes in mucus—ferning, increase in temp(suggest ovulation -labs(hormone levels— -progesterone—do in mid-luteal phase (between ovulation and period) -if not ovulating it wont be up -LH—in urine—do at time you think shes ovulating -LH surge -endometrial bx( -look for secretory changes that happen p ovulation -a lot of money, a lot of pain -if think female is not ovulating( -check— -thyroid -FSH -LH -PRL -Clomid—(clomophine citrate)—50mg from day 5-9 of cycle(stimulates ovulation directly on ovaries and indirect to hypo/pit axis -if it doesn’t work—go up to 50mg to max of 200mg/d -have intercourse on alternate days hoping to catch the egg -works within 6 months—after that—probably wont work -monitor for ovarian enlargement—u/s, pelvic -Glucophage—get rid of hormone resistance -avandi, actos Check Patency of Female Reproductive Tract— -hysterosalpingogram— -radiopaque dye thru cervix—watch under fluroscope(see fill and spill into abd -if dye stops(obstruction -also see masses, fibroids, etc -done by radiologist -do b/t 7th and 11th day of cycle—if earlier(induce retrograde menstration (Sampson) -after 11th(interfere with transport of ovum -suspect tubal pathology(do exploratory lap (or of cant find anything wrong after complete evaluation) Evaluate Male—do at same as female -40% of the time—problem with spermatogenesis -Q73days new batch of sperm -sperm production is thermoregulated—marijuana, Jacuzzi(decrease sperm count -do semen analysis( 
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5CJCJ5\2ab‹ŖŃfs}•§ØČ9}¦Õ. progesterone containing IUD -lighter and lighter cycles -65% decrease over 12 months 2.

LS ratio—lecithin sphyngomyelin -the proportion tells you -2:1(lung is mature -male infants in WV(may not be complete—need higher ratios 2.

298 Considerations on starting a contraceptive( -age -health status -future fertility -sexual pattern (steady / irregular) -need for protection against STDs -understand all methods(they’re personal decision -use the word contraception—better than birth control Goal( -prevent sperm interaction with egg OR -prevent implantation of fertilized ovum 3 Categories— 1.