Labor and Delivery Path Flashcards
how to confirm rupture of membranes
speculum exam looking for pooling of fluid in the posterior vagina
what tests to perform on potential amniotic fluid
nitrazine test - turns blue
slide - ferning
what would ultrasound reveal if ruptured membranes
oligohydramnios
what is premature rupture of membranes (PROM)
rupture of membranes at term (>37wks) prior to the onset of labor, in the absence of uterine contractions
main focus for PROM?
GBS status - start abx prophylaxis if indicated, treat based on risk factors if unknown (prior GBS, prolonged rupture >18hrs)
augmentation of labor
what is preterm premature rupture of membranes (PPROM)
preterm (<37wks) premature (contractions haven’t started) rupture of membranes
what to do if PPROM at >34wks
deliver
what to do PPROM < 24wks
fetus is nonviable and considered aborted
what to do if PPROM 24-34wks?
goal is to weigh risk for infection against benefit of lung maturation and other complications of prematurity
corticosteroids - mature the lungs before delivery
antibiotics
maternal risk of PPROM
infection, hemorrhage
baby risk of PPROM
limb deformity, diseases of prematurity
what is prolonged rupture of membranes
> 18hrs between ROM and delivery
risks of prolonged ROM
group B strep - cover with appropriate abx
puts baby and mom at risk for infection - chorioamnionitis and endometritis after delivery
chorioamnionitis vs. endometritis
chorioamnionitis = baby still inside endometritis = baby has come out
cause of chorioamnionitis/endometritis
ascending infection that goes into the uterus
how may a patient present with chorioamnionitis
PROM or PPROM and fever
what can chorio lead to
sepsis - fever, leukocytosis, tachycardia, tachypnea and absence of other infections
should you culture for chorio?
NO - vagina is not sterile and almost always vaginal flora cause the infection
treatment of chorio
cover for gram negatives and anaerobes with IV broad spectrum abx
- ampicillin + gentamicin + clindamycin
what is the leading cause of neonatal morbidity and mortality?
preterm labor
risk factors of preterm labor
uterine abnormalities and prior preterm delivery
definition of preterm labor
labor (onset of contractions with cervical change) prior to 37wks, but older than abortion (>20wks)
what to do if preterm labor if
help baby mature
- steroids to improve fetal lung development
- tocolytics if <34wks and no contraindication
what are the contraindications to tocolytics/steroids?
maternal: chorioamnionitis, abruption
fetal: demise, fetal distress
tocolytic options
magnesium
calcium channel blockers
prostaglandin inhibitors
rarely ß-agonists
magnesium as a tocolytic
<32 wks for neuroprotection
calcium channel blocker as tocolytic
nifedipine
prostaglandin-inhibitors as tocolytic
indomethacin
- not in >32wks due to theoretical risk of closing ductus arteriosus
ß-agonists as tocolytic
rarely used
for tachysystole only, not turning them off
what are post-dates
a baby >40wks by conception or >42wks by last menstrual period
risk of post-dates
macrosomic baby
- risk of >4000g, being too big to come through a birth canal resultin in arrest of labor or shoulder dystocia, meconium stained fluid leading to meconium aspiration, and carries risk of intrauterine fetal demise (IUFD)
