OB

Question 1

Diagnosis of Chorioamnionitis

Answer 1

Maternal fever > 38C
\+
at least 2 of the following:
- Maternal tachycardia with pulse >120
- Fetal tachycardia with pulse >160
- Uterine tenderness
- Foul-smelling discharge

• WBC >15,000 supportive but not diagnostic

Question 2

Risk factors for chrioamnionitis

Answer 2

• Prolonged rupture of membranes
• multiple digital cervical exams
• placement of a FSE and IUPC
• prolonged labor

Question 3

Etiology of chorioamnionitis

Answer 3

Polymicrobial, common organisms include:
Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, gram negative bacteria, bacteriodes

• Increased risk with Group B strep colonization and BV

Question 4

Treatment of chorioamnionitis

Answer 4

Broad-spectrum antibiotics and supportive therapy

- C -section is not indicated unless fetal or maternal compromise

Question 5

Differential diagnosis of chorioamnionitis

Answer 5

• Pyelonephritis(E coli, Klebsiella, Group B strep, and Proteus), pneumonia, epidural fever(lower grade fever), meningitis(24-48 hours after delivery)

Question 6

Primary syphilis

Answer 6

painless chancre, appears 10-90 days after infection, resolves over 4-6 weeks

Question 7

Secondary syphilis

Answer 7

develops 2-10 weeks after primary resolution
Symptoms: headache, lymphadenopathy, fever, myalgia, fatigue, rash
- Resolves over 3-6 weeks, enters a latency period

Question 8

Tertiary syphilis

Answer 8

Develops 3-15 years after initial infection

- Cardiac, late neurosyphilis, gummatous destruction

Question 9

Syphilis screening tests

Answer 9

RPR and VDRL

Question 10

Treponemal-specific tests

Answer 10

FTA-ABS or TP-PA (treponemal antibody test)

Question 11

Beneficial period for antenatal steroid course

Answer 11

24w - 33 6/7w, in women at risk of delivering in the next 7 days
- Also in women with PROM before 32 weeks

Question 12

Steroids beneficial antenatal effects

Answer 12

Lungs: surfactant production, narrowing of the interalveolar septae, decreased vascular permeability, enhanced clearance of lung fluids

Brain: more mature neuronal communication and synaptic stabilization
Adverse brain effects: inhibition of growth factors and impaired neuronal cell proliferation and myelination

Question 13

When to give second rescue dose of steroids

Answer 13

25w - 32 6/7 w with intact membranes at risk of delivering in next 7 days
- First dose of steroids prior to 30 w and 14 days or more before this dose

Question 14

Risks of greater than two courses of steroids

Answer 14

Maternal: risk of infection, suppression of hypothalamic-pituitary-gonadal axis

Fetal risk: decreased birth weight and head circumference, adrenal suppression,

Question 15

Risk factors for placental abruption

Answer 15

AMA, increased parity, smoking, cocaine use, HTN, PROM, chorio, multiple gestations, maternal trauma, ultrasound finding of subchorionic abruption, history of abruption

Uterine: Mullerian anomalies, leiomyomas