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MIDW 230 > CBL 1_PROM and Early Labour > Flashcards

CBL 1_PROM and Early Labour Flashcards

1
Q

How often does Term PROM occur?

A

8-10 % of all people

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2
Q

How many of Term Prom people go into labour on their own? (2)

A

-Over 50 % in active labour within 1 day
-95 % in active labour in 3 days

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3
Q

Difference bw PPROM and PROM?

A

PROM isn’t pathologic in itself while PPROM carries significant increased risks

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4
Q

Risks of P(reterm)PROM? (3)

A

-clinically evident intra-amniotic infection with histological chorioamnionitis

Fetal risks:
umbilical cord compression
ascending infection.”

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5
Q

How often does intra-amniotic infection occur in PPROM?

A

15-25 % of all birthers

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6
Q

How often does histological chorio occur in PPROM?

A

51 % of all birthers

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7
Q

Risk factors of PPROM? (13)

A

-Disorders of the cervix, either iatrogenic (e.g., operative), or not (e.g., insufficiency) · PPROM in a previous pregnancy ·
-Prior preterm labour/delivery ·
-Chronic placental abruption ·
-Polyhydramnios
-Multiple pregnancy ·
-Short interpregnancy interval of less than 6 months ·
-Cigarette smoking ·
-Sexually transmitted infection ·
-Low socioeconomic status ·
-Amniocentesis ·
-Periodontal disease
-Gestational Diabetes Mellitus
-Bacterial vaginosis (BV)

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8
Q

How long no ctx with ROM to be considered PROM?

A

1 hour

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9
Q

What is prolonged ROM?

A

ROM for more than 18 hours with ctxs (kind of an arbitrary number)

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10
Q

How many exp. managed Term PROM will be in active labour within 1 day?

A

Over 50 %

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11
Q

How many exp. managed Term PROM will be in labour within 3 days?

A

95 %

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12
Q

How many people with leaking fluid have PROM?

A

95 %

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13
Q

What should be asked with Query PROM? (9)

A
  • Presence of leaking fluid
  • Amount
  • Timing
  • Odor
  • Persistance
  • Colour
  • FM
  • Cx
  • fever?
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14
Q

When should IOL be offered with PROM for GBS neg/unknown?

A

12-24 hours or immediately if client wants

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15
Q

When should IOL and abx be offered for PROM GBS +?

A

Both immediately SOGC

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16
Q

PROM care plan for GBS + (AOM)?

A

Ideally prenatal discussion.

  • Give SOGC reccomendation: Immediate IOL and Antibiotic prophylaxis
  • discuss research gap regarding most effective approach to preventing EOGBSD
  • Acknowledge and proceed depending on client preferences and values
  • If client choses expectant management at this time, remind client of recommendation for medical IOL for PROM at18hrs & antibiotics at start of labour
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17
Q

Pelvic precautions for PROM? (5)

A

-Nothing in vagina
-Blot rather than wipe
-Change pad often
-Take temp q4 hours when awake
-Page if temp 38 degrees C or higher

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18
Q

PROM Assessment Care plan? (2)

A

-Prompt assessment if any abnormal findings/unclear re history
-Assessment Within 24 hours if history is clear, signs/symptoms are normal, and they choose a period of exp. mgmt.

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19
Q

What should be assessed in person to confirm query PROM?(4)

A
  • Sterile spec
  • GBS swab if none done yet
  • Nitrizine
  • Ferning sample
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20
Q

What is looked at in sterile spec? (4)

A
  • Fluid pooling in posterior fornix
  • Free flow of fluid from cvx
  • Cord prolapse
  • Dilation, effacement, position
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21
Q

How do you collect a ferning specimen? (4)

A

-Obtain fluid from posterior fornix
-Place on glass slide
-let air dry for 10 mins
-look under microscope

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22
Q

What is ferning?

A

Crystallization of sodium chloride = presence of amniotic fluid

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23
Q

What can cause false positive with nitrizine amniotic fluid assessment? (4)

A
  • Blood
  • Alkaline vag infections (BV)
  • Alkaline urine
  • Semen.
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23
Q

What can cause false negative with amniotic fluid assessment?

A

Prolonged ROM with little residual fluid

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24
Q

What colour does positive nitrizine turn?

A

Dark Blue from yellow, with pH above 6.5

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25
Q

How accurate is nitrizine?

A

Sensitive but not specific

Often says ‘positive’

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26
Q

What is the normal pH of pregnancy vag?

A

4.5 -6.0

27
Q

What is pH of amniotic fluid?

A

7.1-7.3

28
Q

What can cause a false positive with ferning (4)?

A

Antiseptic solution
Semen
Fingerprints
cervical mucus

29
Q

Is ferning a conclusive test?

A

No, it’s supportive rather than conclusive in non-labouring clients with non-specific vaginal fluid loss

30
Q

What won’t cause a false positive with ferning? (3)

A

Blood
Mec
Vaginal secretions

(don’t ask me what the difference bw from vag secretions and cervical fluids is…)

31
Q

What is a more specific and sensitive test for AF?

A

Amnisure – more expensive
(placental alpha microglobulin-1)
The sensitivity ranges from 94.8 to 98.9% and the specificity from 87.5 to 100%;

32
Q

Is it reasonable for someone to stay home with PROM?

A

Yes, if IOL is declined and VEs avoided.
All else: of course they can but higher risks

33
Q

Recommendations for Expectant Mgmt PROM ALARM? (7)

A

-avoid VEs

-observe infection:
monitor maternal pulse and temperature
FHR
uterine tenderness

-give abx and IOL ifchorioamnionitis develops

-educate to report signs of infection or decreased FM

-FM/FHR evaulatued every 24 hours

-when in labour after term PROM > 24 hours, EFM in labour is recommended (AOM differs)

-asymptomatic healthy term babies born after 24 hours of PROM should be observed for the first 12 hours for signs of infection (AOM routine pp care)

34
Q

What is the CD rate in BC in BC 2021?

A

37.8 % )

35
Q

What is the CD rate for nulips with spontaneous labour in BC 2021?

A

24.3 %

36
Q

What is Term PROM?

A

Term ROM with no ctx for more than 18 hours (which is an arbitrary number)

37
Q

What is the CD rate for nulips with IOL in BC 2021?

A

52.6 % (2x higher than nulips w spont. labour)

38
Q

What is Prolonged ROM?

A

ROM in with ctx for greater than 18 hours

39
Q

What are the risks of prolonged ROM?

A

Increased chance of infection for mom and bb

40
Q

How to monitor prolonged ROM?

A

Increased surveillance of temp (q2 hours)
No Mec/risk factors = IA is fine

41
Q

What causes spontaneous labour?

A

Not fully known, activated by fetus and caused by cascade of positive feedback loops
VAL WISDOM: wow so complex and mysterious, our job = don’t mess with it

42
Q

What is the risk of misidentifying early labour?

A

Mistaking Early L for Active L can contribute to unnecessary interventions related to ‘failure to progress’

43
Q

Non pharm strategies for coping in early labour?

A
  • Coping strategies prenatally and education around long early labour can be
  • Continuous support from a support person
  • Staying at home/home like environment
  • Focused breathing/meditation
  • Heat, cold
  • TENS machine
  • Intuitive, upright positions
  • Distracting activities
  • Positioning:
     OP position is associated with longer labours, increased back pain, increased need for pain management, dystocia, and adverse conditions and outcomes
     Support optimal fetal positioning by encouraging clients to get into positions such as hands and knees and side-lying
     Hands and knees position and sterile water injections can also relieve back pain associated with OP fetal positioning (1,2,3,5)
44
Q

Early labour pharm methods? (4)

A

-Tylenol and gravol
-IM morphine and gravol
-IV hydration
-IM gravol (hb)

45
Q

Triaging PROM? (10)

A

Hx
GBS status
red flags
fluid
amount
time
fetal well-being -movement and fetal presentation last time you saw them
contraction pattern
coping
‘are you feeling well’,

46
Q

Options to confirm PROM?(5)

A

Sterile spec and pooling

Nitrizine - not accurate, kind of crap - needs to be up in the cervix (not when it’s trickled down the vagina with mucus, blood, and urine)

Ferning

US - not diagnostic, but info that could be relevant

“Amnisure” - placental alpha microglobilin test (expensive) (but what is this cost compared to induction - Val wisdom)

47
Q

Can you have baths with PROM

A

No baths till active labour

48
Q

What is the likelihood of chorio with PROM and no VEs?

A

Low

49
Q

When is ideal IOL for term PROM?

A

There is a research gap

50
Q

What does the evidence say about IOL vs exp mgmt. for PROM?

A

Low Risk term PROM =

evidence to support safety of IOL or expectant mgmt

51
Q

What are the issues with TERM PROM RCT?(3)

A
  • Overly broad defn around chorio
  • More VE for exp mgmt than IOL group
  • No screening/treating GBS
52
Q

What are abnormal findings where IOL may be a good choice for TERM PROM? (5)

A

Mec
Bad smelling fluid
Active vag bleeding
Fever above 38
Decreased FM

53
Q

What is the biggest risk factor for infection of birther and babe with low risk term PROM?

A

Frequent VES before active labour

54
Q

How much does AOM recommend for PROM timing?

A

96 hours

55
Q

How much does ACOG recommend for PROM timing?

A

12-24 hours

56
Q

How much does NICE recommend for PROM timing?

A

24 hours

57
Q

What should be included in monitoring of exp mgmt PROM?(2)

A
  • When/how to page
  • Daily in person assessments (birthing person’s VS, FHR, FM)
58
Q

Are daily NSTs evidence based for low-risk Term PROM?

A

Not if we don’t view PROM as a pathology (VAL HOT TAKE)

59
Q

What does SOGC recommend with fetal monitoring in labour for PROM?

A

CEFM if PROM greater than 24 hours

60
Q

What doess AOM recommend for PROM timing and FHS? (evidence based)

A

IA is reasonable if no risk factors present (AOM) (no mec or fever)

61
Q

What does WHO say the ideal CD rate should be?

A

(WHO recommends ideal CD rate 10-15%

62
Q

What is Prolonged early labour?

A

Latent phase lasting over 14 hours in multip/20h in nullip

63
Q

Risks of prolonged early labour?

A

Dehydration
Exhaustion

64
Q

Non-pharmacological early labour support?

A

Continuous support person
Staying home; music; relaxed breathing; massage; counter pressure; TENS
Use of water
Intuitive movement, upright position; birth ball, etc
Encourage rest, eating, hydration
Emotional support and reassurance
Fetal position impacts labour: encourage hands and knees; side-lying for OP
Sterile water injections

65
Q

GBS stats for ICD?

A

15-40% of pregnant ppl are GBS pos
40-70% of babies born to GBS pos birther will be colonized if untreated
1-2% of colonized NB will develop infection if untreated
5% of NB who develop infection will die

MIDW 230 (13 decks)

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