PPROM, Cord prolapse + breech

Question 1

What is PPROM?

Answer 1

Gush of fluid due to rupture of membranes not directly preceding labour + <37 weeks

Question 1

What does pprom stand for?

Answer 1

preterm Premature rupture of membranes

Question 2

Causes of pprom?

Answer 2

Trauma
TORCH infection
CVS (chorionic villus sampling)
Amniocentesis
BV

Question 3

Dx of pprom?

Answer 3

Speculum = fluid pooled in post fornix
USS = oligohydromnias (low amniotic fluid)

Question 4

Tests to check for pprom?

Answer 4

Nitrazine test - positive >pH7.1
Positive strip - turns blue

Fern test Positive

(or IGF-1/PAMG-1 test)

Question 5

how does the nitrazine test work?
What would be the result?

Answer 5

measures vaginal pH of expectant mothers to determine rupture
Checks if its vaginal or amniotic fluid

Question 6

What pH is vaginal and amniotic fluid?

Answer 6

Vaginal - pH 4.5-6
Amniotic - pH 7.1-7.3

Question 7

What does the fern test check?

Answer 7

Check if fluid is cervical mucus

Question 8

Treatment for PPROM?

Answer 8

10 day PO erythromycin 250mg QDS
Antenatal steroids

Question 9

What would they take if allergic to erythomycin?

Answer 9

Amoxicillin 500mg QDS

Question 10

Why do mothers need to take erythromycin?

Answer 10

To prevent chorioamnionitis - ascending infection of chorion by E.COLI or GBS

Question 11

What are symptoms of Chorioamnionitis?

Answer 11

HIE (Hypoxic-ischemic encephalopathy)
Stillbirth
RDS (Resp distress syndrome)

Question 12

What antenatal steroids should be taken, when and how?

Answer 12

Dexamethasone or Betamethasone 12mg IM
2 doses 24 hours apart up to 34+6 weeks

Question 13

What is cord prolapse?

Answer 13

Umbilical cord presents + exits cervix before baby +/- visible through intravasities
EMERGENCY

Question 14

risk factors for cord prolapse?

Answer 14

Polyhydramnios (too much amniotic fluid)
Abnormal fetal lie
A.R.M
Placenta/vasa previa
multiple pregnancies
breech
low birth weight

Question 15

Symptoms of cord prolapse

Answer 15

Visible cord and fetal bradycardia

Question 16

Diagnosis of cord prolapse?

Answer 16

Speculum = presence of cord in birth canal
Fetal Hb
CTG - monitor fetal HR and maternal contractions

Question 17

Treatment of cord prolapse?

Answer 17

A-E assessment

Go on all 4s to reduce pressure on cord
or knee to chest/LLP

C section if needed (cat 1 if fetal distress, cat 2 is non)

Manually elevate head
Consider catheterisation (bladder full = better) - prevents further prolapse (eg. 500ml warm saline)

Consider TOCOLYTICS eg. terbutaline to stop contractions + buy time for c section

Question 18

Complication of cord prolapse?

Answer 18

Nuchal cord (cord around neck)
fetal ischemia

Question 19

What is Breech?

Answer 19

Breech position is the foetus in a longitudinal lie, with buttock +/- feet proximal to cervix + head near fundus

Question 20

What are the 3 types of breech and %?

Answer 20

Frank 60%
complete 30%
footling 10%

Question 21

What are all the breeches positions?

Answer 21

Complete - feet flexed at hip and knee

Footling - one leg flexed at hip and knee, other leg is flexed at hip but extended knee

Frank - flex at hip, extended knees

Question 22

RF of breech?

Answer 22

polyhydramnios
Premature

Question 23

Investigations for breech babies?

Answer 23

all breech babies need USS of hip

Question 24

How is a breech baby detected?

Answer 24

through physical exam and confirmed via USS

Question 25

treatment of breech?

Answer 25

External cephalic version (ECV) offered at 36 weeks (primiparous) and 37 weeks (multiparous)

Question 26

Breech risks?

Answer 26

DOH
HIE
Uterine rupture