Multifetal Gestation and PPROM Flashcards
Definition of PPROM
Preterm Premature Rupture of Membrane → prior to 37 wks, prrior to onset of contractions/labor, amniotic sac ruptures and contents leak into vagina
what are the risk factors for PPROM?
prior history, smoker, age < 18 or > 40, low BMI/poor nutrition, low SES, antepartum bleeding
what do you need to distinguish PPROM from since it may have similar signs?
urinary incontinence
How will a woman with PPROM present?
c/o large gush or trickle of fluid, continuous small leak, increased vaginal discharge, bleeding, pain, fever/chills
What tests can you do to diagnose PPROM?
valsalva test low amniotic fluid on US Fern Test (diagnostic) Nitrazine (check for increase in pH) AmniSure (\$\$)
what is the information you need to include when admiting a patient?
ADC VAN DIMAL
admit, diagnosis, condition, vitals, activity, nursing, diet, I and O, meds, allergies, labs
What are factors that influence how you manage PPROM?
gestational age, +/- infection, +/- labor, fetal well being, NICU availability
Patient presents with PPROM, what is your first step?
admit to inpatient immediately
What would indicated immediate delivery is needed in patient with PPROM?
nonreassuring fetal monitoring, cord prolapse, labor, heavy bleeding, over infection
what is commonly associated with PPROM?
abruptio placentae
In PPROM, what can you initiate in a patient to mature fetal lungs?
betamethasone (steroid)
what meds to you initially give in patient with PPROM?
betamethasone, magnesium sulfat (<32 wks fetal neuroprotection), latency antibiotics
Latency antibiotics used prophylactically in PPRom cover what?
Chlamydia trachomatis, Group B strep, Ureaplasmas
What are two combinations used in PPROM for prophylaxis?
ampicillin + azthromycin IV
amoxicillin + erythromycin PO
Why are latency antibiotics benefitial in PPROM?
increases time between rupture and spontaneous labor
reduces frequency of maternal/fetal infection
How long should you prophylactically give antibiotics with PPROM?
7 days → 2 days IV and 5 days PO
Management for PPROM is present >34 weeks
deliver
Management of PPROM present at 24-33 weeks
inpatient until delivery
labor/infection/fetal distress → deliver