Labor and Delivery Path

Question 1

how to confirm rupture of membranes

Answer 1

speculum exam looking for pooling of fluid in the posterior vagina

Question 2

what tests to perform on potential amniotic fluid

Answer 2

nitrazine test - turns blue

slide - ferning

Question 3

what would ultrasound reveal if ruptured membranes

Answer 3

oligohydramnios

Question 4

what is premature rupture of membranes (PROM)

Answer 4

rupture of membranes at term (>37wks) prior to the onset of labor, in the absence of uterine contractions

Question 5

main focus for PROM?

Answer 5

GBS status - start abx prophylaxis if indicated, treat based on risk factors if unknown (prior GBS, prolonged rupture >18hrs)
augmentation of labor

Question 6

what is preterm premature rupture of membranes (PPROM)

Answer 6

preterm (<37wks) premature (contractions haven’t started) rupture of membranes

Question 7

what to do if PPROM at >34wks

Answer 7

deliver

Question 8

what to do PPROM < 24wks

Answer 8

fetus is nonviable and considered aborted

Question 9

what to do if PPROM 24-34wks?

Answer 9

goal is to weigh risk for infection against benefit of lung maturation and other complications of prematurity
corticosteroids - mature the lungs before delivery
antibiotics

Question 10

maternal risk of PPROM

Answer 10

infection, hemorrhage

Question 11

baby risk of PPROM

Answer 11

limb deformity, diseases of prematurity

Question 12

what is prolonged rupture of membranes

Answer 12

> 18hrs between ROM and delivery

Question 13

risks of prolonged ROM

Answer 13

group B strep - cover with appropriate abx

puts baby and mom at risk for infection - chorioamnionitis and endometritis after delivery

Question 14

chorioamnionitis vs. endometritis

Answer 14

chorioamnionitis = baby still inside
endometritis = baby has come out

Question 15

cause of chorioamnionitis/endometritis

Answer 15

ascending infection that goes into the uterus

Question 16

how may a patient present with chorioamnionitis

Answer 16

PROM or PPROM and fever

Question 17

what can chorio lead to

Answer 17

sepsis - fever, leukocytosis, tachycardia, tachypnea and absence of other infections

Question 18

should you culture for chorio?

Answer 18

NO - vagina is not sterile and almost always vaginal flora cause the infection

Question 19

treatment of chorio

Answer 19

cover for gram negatives and anaerobes with IV broad spectrum abx
- ampicillin + gentamicin + clindamycin

Question 20

what is the leading cause of neonatal morbidity and mortality?

Answer 20

preterm labor

Question 21

risk factors of preterm labor

Answer 21

uterine abnormalities and prior preterm delivery

Question 22

definition of preterm labor

Answer 22

labor (onset of contractions with cervical change) prior to 37wks, but older than abortion (>20wks)

Question 23

what to do if preterm labor if

Answer 23

help baby mature

• steroids to improve fetal lung development
• tocolytics if <34wks and no contraindication

Question 24

what are the contraindications to tocolytics/steroids?

Answer 24

maternal: chorioamnionitis, abruption
fetal: demise, fetal distress

Question 25

tocolytic options

Answer 25

magnesium
calcium channel blockers
prostaglandin inhibitors
rarely ß-agonists

Question 26

magnesium as a tocolytic

Answer 26

<32 wks for neuroprotection

Question 27

calcium channel blocker as tocolytic

Answer 27

nifedipine

Question 28

prostaglandin-inhibitors as tocolytic

Answer 28

indomethacin

- not in >32wks due to theoretical risk of closing ductus arteriosus

Question 29

ß-agonists as tocolytic

Answer 29

rarely used

for tachysystole only, not turning them off

Question 30

what are post-dates

Answer 30

a baby >40wks by conception or >42wks by last menstrual period

Question 31

risk of post-dates

Answer 31

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)