Dunn OB/GYN III Flashcards
PPROM
preterm premature rupture of membranes
if before 37 weeks
risk of PPROM
pervious PROM
preterm labor
vaginal uteral infection
smoking
digital exam
with ruptured membrane
-don’t want to introduce bacteria
nitrazine
examine pH
blood and semen - false positive
ferning
amniotic fluid
33yoF, gush of clear fluid, 30 weeks, nitrazine and ferning positive
PPROM - diagnosis
PROM
premature rupture of membranes
spontaneous rupture - prior to onset of labor
midterm PROM
14-26 weeks
risk factors for PPROM
infection - GI** previous PPROM antepartum bleeding smoking - 2-4x increased mechanical stress - twins, trauma, polyhydramnios
management of PPROM
admit to labor and delivery
-confirm diagnosis
infection or bad fetal status - delivery
stable mother and fetus - hospitalize until delivery
-antenatal corticosteroids, antibiotics, monitor
at 34 weeks - deliver
-check lung maturity
1/3 women with PPROM
potential serious intrauterine infections
increased risk for placental abruption, umbilical cord prolapse, pulmonary hypoplasia
PPROM 24-32 weeks
antibiotics and group B strep at delivery if indicated
32-34 weeks PPROM
antibiotics and group B strep prophylaxis at delivery if indicated
> 34 weeks PPROM
group B strep prophylaxis beyun on admission and continued until delivery
antibiotics for PPROM
ampicillin 2g IV once, followed by 1g q6hrs
steroids and PPROM
only if patient <34 weeks
for fetal lung maturity
betamethasone
corticosteroid
for fetal lung maturity
12mg IM daily - 2 doses
tocolytics
stop labor
-delay delivery for 48 hours
Mg sulfate
magnesium sulfate
decreases uterine tone and contraction - acts as calcium antagonist and membrane stabilizer
watch for headache, flushing, fatigue, diplopia
toxic levels - resp and cardiac arrest
group B strep
ampicillin
azithromycin
genital mycoplasmas
protect chorioamnionitis and provide chlamydia coverage
PCN allergy
cefalozin and cephalexin
or clindamycin and gentamycin
intraamniotic infection
chorioamnionitis
infection of amniotic fluid, membranes, placenta, and or decidua
20-40% early neonatal sepsis and pneumonia
cervicovaginal flora migration
membrane rupture - facilitates process
transplacental infection
uncommon chorioamnionitis
-listeria monocytogenes
other uncommon methods of chorioamnionitis infection
amniocnentesis
chorionic villus sampling
fetal surgery
chorioamnionitis organisms
ureaplasma urealyticum gram negative anaerobes mycoplasma hominis bacteroids bivius gardnerella vaginalis group B strep - 15%
risk fx for chorioamnionitis
long labor long membrane rupture digital vaginal exams nulliparity previous meconium in amniotic fluid internal fetal monitoring alcohol tobacco genital tract pathogens PROM
fever, uterine tenderness, maternal tachy, fetal tachy, purulent amniotic fluid, maternal leukocytosis >12,000
chorioamnionitis
fetal tachy
> 160
risks with chorioamnionitis
labor abnormalities
dysfunctional uterine myometrium - inflammation
C section - wound infection, endomyometritis, venous thrombosis
diagnosis of chorioamnionitis
fever maternal leukocytosis maternal/fetal tachy uterine tenderness foul odor of amnionitic fluid
culture of amniotic fluid
gold standard for intrauterine infection - most specific
limited by fact that it takes days to get results
so not clinically useful
treatment of chorioamnionitis
IV ampicillin q6hrs
gentamicin q8hrs
PCN allergic patient with chorioamnionitis
vancomycin IV q12hrs
27yo G3P1 F
- severe abdominal pain during labor and cessation of contraction
- low BP, tachycardia
- dry mucous membrane
- no fetal heart sounds
uretine rupture
uterine rupture
frequent cause of maternal and fetal death in developing countries
classification of uterine rupture
spontaneous vs. traumatic
complete vs. incomplete
anatomical site
hx with uterine rupture
previous C section, uterine surgery, cervical cerclage
risk fx uterine rupture
previous uterus surgery uterotonic drug use prolonged and obstructed albor early pregnancy in young malnutrition
tx of uterine rupture
initial - resuscitation with crystalloid fluids, blood products
gastric decompression
urinary cath
broad spectrum antibiotics
TAH
tx order of uterine rupture
uterine massage IV access/bladder cath oxygen labs electrolytes oxytocin cytotec hemabate bakri balloon tranexamic acid D and C
HTN
no methergine
asthma
no hemabate
