Obstetrical Complications PROM and On

Question 1

Should you check the cervix of a presumed ruptured preterm patient?

Why/Why not?

Answer 1

1) No

2) It increases risk of infection

Question 2

PPROM should be confirmed using what?

Answer 2

Sterile speculum

Question 3

When confirming PPROM diagnosis, nitrazine paper should turn __1__ and pooling/ferning can be used

May also use ultrasound to evaluate __2__ to aid in diagnosis.

Answer 3

1) Blue

2) Amniotic fluid volume

Question 4

MANAGEMENT OF PPROM depends on gestational age at time of rupture and amniotic fluid index

1) What happens if rupture happens less than 24 week?
2) For Amniotic fluid index, Any value less than 5 cm is considered __2__.

Answer 4

1) Pulmonary hypoplasia
2) Oligohydramnios

*Ruptured membrane->less fluid in body->not enough fluid for pulmonary development+ not enough fluid in general

Question 5

In the management of PPROM, the goal is to continue the pregnancy until?

Most will deliver at how many weeks regardless of the above happening?

Must monitor for signs/symptoms of?

Answer 5

1) Lungs mature
2) 34 weeks
3) Chorioamnionitis

Question 6

In the management of PPROM with antibiotic usage

The ACOG recommends a 48 hour course of IV __1__ and __1__ followed by 5 days of __2__ and __2__.

Answer 6

1) Ampicillin and Erythromycin/ Azithromycin

2) Amoxil and Erythromycin

Question 7

In managing PPROM, What does steroid use up to 34 weeks of gestation reduce the risk of?

Answer 7

Respiratory distress syndrome

Question 8

The substances phosphatidylcholine (lecithin),

phosphatidylinositol (PI) and phosphatidylglycerol (PG) are important for ____.

Answer 8

Fetal lung maturity

Question 9

To test for Fetal Lung Maturity,

1) What increases rapidly after 35 weeks gestation?
2) What remains the same (Known as the L/S) Ratio

L/S ratio is a measure of fetal lung maturity; ratio greater than __3__ is classified as mature.

Because these substances are affected by blood or meconium, the presence of __4__ is diagnostic of mature lungs because it is not affected by presence of blood or meconium.

Answer 9

1) Lecithin
2) Sphingomyelin
3) Two
4) Phosphatidylglycerol (PG)

Question 10

What is a rapid test for Fetal Lung Maturity?

Answer 10

Lamellar Body Number Density assessment (LBND)

Question 11

__1__ is when the birth weight of a newborn is below the 10% for a given gestational age.

__2__ is birth weight at the lower extreme of normal birth weight distribution.

Answer 11

1) Intrauterine Growth Restriction (IUGR) *This is due to environmental or genetic factor FYI
2) SGA (small for gestational age)

Question 12

1) What are the 3 main categories of IUGR?
2) Maternal causes of Intrauterine Growth Restriction can be due to what nutritional factors?
3) What substance uses are maternal causes of IUGR?
4) What syndrome is a maternal cause of IUGR?

Answer 12

1) Maternal, Fetal Placental
2) Poor nutritional intake/ Low maternal body weight
3) Smoking and alcohol
4) Antiphospholipid syndrome

Question 13

Insufficient substrate transfer through __1__ can cause IUGR.

Defective __2__ invasion can cause IUGR.

Answer 13

1) Placenta

2) Trophoblast

Question 14

What infections diseases are fetal causes of IUGR?

Answer 14

1) Listeriosis

2) TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes)

Question 15

Serial ____ measurement is primary screening tool for IUGR.

Answer 15

Fundal height (Pubic bone to top of uterus)

Question 16

If fundal height lags more than 3 cm behind the gestational age then what should be ordered?

Answer 16

Ultrasound

Question 17

In the management of IUGR, WHEN should optimizing disease processes such as
-blood sugar control in diabetes and
-control of hypertension
Be done?

Answer 17

Pre-pregnancy

Question 18

The goal of antepartum management of IUGR is?

Answer 18

Deliver before fetal compromise but after fetal lung maturity

Question 19

Non Stress Testing

With the patient in the lateral tilt position, the fetal heart rate is monitored with an external transducer. The tracing is observed for fetal heart rate accelerations that peak at least __1__ beats per minute above the baseline and last __2__ seconds from baseline to baseline. It may be necessary to continue the tracing for 40 minutes or longer to take into account the variations of the fetal sleep-wake cycle.

Answer 19

1) 15 bpm

2) 15 seconds

Question 20

The ____ consists of a nonstress test combined with four observations made by real-time ultrasonography.

What are the 4 observations?

Answer 20

Biophysical Profile

Fetal

1) Breathing movement
2) Movement
3) Tone
4) Amniotic Fluid Volume

Question 21

Biophysical profile Normal Levels

1) How much Fetal breathing rhythmic movements in 30 minutes?
2) How much Fetal Movement of limbs in 30 minutes?
3) What needs to occur for Fetal Tone? (Extremity)
4) Normal amniotic fluid volume

Answer 21

1) 30 seconds (of fetal breathing rhythmic movement)
2) 3 movements
3) Extension then Flexion or Open/Close hand
4) 2 cm

Question 22

1) Doppler US accesses what?

2) What body part does it assess?

Answer 22

1) Vascular impedance

2) Umbilical artery

Question 23

What is the diastolic flow for Normal fetus Umbilical Artery?

With Intrauterine Growth restriction?

Answer 23

1) High velocity flow

2) Reduced flow

Question 24

If ultrasound shows IUGR between 3rd and 10th percentile with normal dopplers than deliver between __1__ weeks.

If ultrasound shows IUGR less than 3rd percentile it is recommended to deliver at __2__ weeks.

Answer 24

1) 38-39 weeks

2) 37 weeks

Question 25

After delivery with IUGR, What do you monitor because infant has low hepatic glycogen stores?

Answer 25

Blood glucose levels

Question 26

Post-term pregnancy is a pregnancy that continues past ____ weeks.

Answer 26

42 weeks

Question 27

Post-term pregnancy may be associated with what rare congenital kidney condition?

It may be associated with what condition characterized by neural tube defect missing part of brain, skull and scalp?

It may be associated with what what x-linked disease that prevents conversion of estrogen precursors?

Answer 27

1) Fetal adrenal hypoplasia
2) Anencephalic fetuses
3) Placental sulfatase deficiency

PAF

Question 28

In the management of postterm pregnancy, if there is abnormal testing or oligohydramnios in the ___ week you want to induce labor.

Answer 28

41st week

Question 29

1) Intrauterine Fetal Demise is characterized by fetal death Between when?
2) Mothers are at risk of what?

Answer 29

1) 20 weeks to Onset of labor

2) DIC

Question 30

When searching for the cause of Intrauterine Fetal Demise, what do you order?

Answer 30

1) Parvovirus studies TORCH titers
2) Listeria cultures
3) Anticardiolipin antibodies
4) TORCH titers

PLAT