PPROM, Cord prolapse + breech Flashcards
What is PPROM?
Gush of fluid due to rupture of membranes not directly preceding labour + <37 weeks
What does pprom stand for?
preterm Premature rupture of membranes
Causes of pprom?
Trauma
TORCH infection
CVS (chorionic villus sampling)
Amniocentesis
BV
Dx of pprom?
Speculum = fluid pooled in post fornix
USS = oligohydromnias (low amniotic fluid)
Tests to check for pprom?
Nitrazine test - positive >pH7.1
Positive strip - turns blue
Fern test Positive
(or IGF-1/PAMG-1 test)
how does the nitrazine test work?
What would be the result?
measures vaginal pH of expectant mothers to determine rupture
Checks if its vaginal or amniotic fluid
What pH is vaginal and amniotic fluid?
Vaginal - pH 4.5-6
Amniotic - pH 7.1-7.3
What does the fern test check?
Check if fluid is cervical mucus
Treatment for PPROM?
10 day PO erythromycin 250mg QDS
Antenatal steroids
What would they take if allergic to erythomycin?
Amoxicillin 500mg QDS
Why do mothers need to take erythromycin?
To prevent chorioamnionitis - ascending infection of chorion by E.COLI or GBS
What are symptoms of Chorioamnionitis?
HIE (Hypoxic-ischemic encephalopathy)
Stillbirth
RDS (Resp distress syndrome)
What antenatal steroids should be taken, when and how?
Dexamethasone or Betamethasone 12mg IM
2 doses 24 hours apart up to 34+6 weeks
What is cord prolapse?
Umbilical cord presents + exits cervix before baby +/- visible through intravasities
EMERGENCY
risk factors for cord prolapse?
Polyhydramnios (too much amniotic fluid)
Abnormal fetal lie
A.R.M
Placenta/vasa previa
multiple pregnancies
breech
low birth weight
Symptoms of cord prolapse
Visible cord and fetal bradycardia
Diagnosis of cord prolapse?
Speculum = presence of cord in birth canal
Fetal Hb
CTG - monitor fetal HR and maternal contractions
Treatment of cord prolapse?
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
Complication of cord prolapse?
Nuchal cord (cord around neck)
fetal ischemia
What is Breech?
Breech position is the foetus in a longitudinal lie, with buttock +/- feet proximal to cervix + head near fundus
What are the 3 types of breech and %?
Frank 60%
complete 30%
footling 10%
What are all the breeches positions?
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
RF of breech?
polyhydramnios
Premature
Investigations for breech babies?
all breech babies need USS of hip
How is a breech baby detected?
through physical exam and confirmed via USS
treatment of breech?
External cephalic version (ECV) offered at 36 weeks (primiparous) and 37 weeks (multiparous)
Breech risks?
DOH
HIE
Uterine rupture
