Obstetrical Complications PROM and On Flashcards
Should you check the cervix of a presumed ruptured preterm patient?
Why/Why not?
1) No
2) It increases risk of infection
PPROM should be confirmed using what?
Sterile speculum
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.
1) Blue
2) Amniotic fluid volume
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__.
1) Pulmonary hypoplasia
2) Oligohydramnios
*Ruptured membrane->less fluid in body->not enough fluid for pulmonary development+ not enough fluid in general
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?
1) Lungs mature
2) 34 weeks
3) Chorioamnionitis
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__.
1) Ampicillin and Erythromycin/ Azithromycin
2) Amoxil and Erythromycin
In managing PPROM, What does steroid use up to 34 weeks of gestation reduce the risk of?
Respiratory distress syndrome
The substances phosphatidylcholine (lecithin),
phosphatidylinositol (PI) and phosphatidylglycerol (PG) are important for ____.
Fetal lung maturity
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.
1) Lecithin
2) Sphingomyelin
3) Two
4) Phosphatidylglycerol (PG)
What is a rapid test for Fetal Lung Maturity?
Lamellar Body Number Density assessment (LBND)
__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.
1) Intrauterine Growth Restriction (IUGR) *This is due to environmental or genetic factor FYI
2) SGA (small for gestational age)
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?
1) Maternal, Fetal Placental
2) Poor nutritional intake/ Low maternal body weight
3) Smoking and alcohol
4) Antiphospholipid syndrome
Insufficient substrate transfer through __1__ can cause IUGR.
Defective __2__ invasion can cause IUGR.
1) Placenta
2) Trophoblast
What infections diseases are fetal causes of IUGR?
1) Listeriosis
2) TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus and herpes)
Serial ____ measurement is primary screening tool for IUGR.
Fundal height (Pubic bone to top of uterus)
If fundal height lags more than 3 cm behind the gestational age then what should be ordered?
Ultrasound
In the management of IUGR, WHEN should optimizing disease processes such as
-blood sugar control in diabetes and
-control of hypertension
Be done?
Pre-pregnancy
The goal of antepartum management of IUGR is?
Deliver before fetal compromise but after fetal lung maturity
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.
1) 15 bpm
2) 15 seconds
The ____ consists of a nonstress test combined with four observations made by real-time ultrasonography.
What are the 4 observations?
Biophysical Profile
Fetal
1) Breathing movement
2) Movement
3) Tone
4) Amniotic Fluid Volume
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
1) 30 seconds (of fetal breathing rhythmic movement)
2) 3 movements
3) Extension then Flexion or Open/Close hand
4) 2 cm
1) Doppler US accesses what?
2) What body part does it assess?
1) Vascular impedance
2) Umbilical artery
What is the diastolic flow for Normal fetus Umbilical Artery?
With Intrauterine Growth restriction?
1) High velocity flow
2) Reduced flow
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.
1) 38-39 weeks
2) 37 weeks
After delivery with IUGR, What do you monitor because infant has low hepatic glycogen stores?
Blood glucose levels
Post-term pregnancy is a pregnancy that continues past ____ weeks.
42 weeks
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?
1) Fetal adrenal hypoplasia
2) Anencephalic fetuses
3) Placental sulfatase deficiency
PAF
In the management of postterm pregnancy, if there is abnormal testing or oligohydramnios in the ___ week you want to induce labor.
41st week
1) Intrauterine Fetal Demise is characterized by fetal death Between when?
2) Mothers are at risk of what?
1) 20 weeks to Onset of labor
2) DIC
When searching for the cause of Intrauterine Fetal Demise, what do you order?
1) Parvovirus studies TORCH titers
2) Listeria cultures
3) Anticardiolipin antibodies
4) TORCH titers
PLAT
