PPROM, PTD

Question 1

What tests should be done after PPROM is confirmed?

Answer 1

CBC
GBS
Trichomonas and BV
Genprobe
Ultrasound for AFI; fetal growth, position, and anatomy; BPP
Cardiotocography to monitor fetal heart rate (including a nonstress test) and frequency of uterine contractions

Question 2

The benefit needs to be balanced with the risks of PPROM-associated complications and their sequelae in expectantly managed pregnancies: these are?

Answer 2

Intramniotic infection
Placental abruption
Cord prolapse/compression.

Question 3

Most patients who are initially managed expectantly should be delivered when?

Answer 3

34 weeks of gestation.

Question 4

Is administration of antenatal steroids for pregnancies that present with PPROM in the 22nd week of gestation reasonable?

Answer 4

Yes- if delivery in the next 7 days is anticipated and the family desires aggressive neonatal intervention after thorough consultation with maternal-fetal medicine and neonatology specialists.

Question 5

Is meconium an indication for delivery in PPROM?

Answer 5

Patients with PPROM and meconium-stained amniotic fluid should be evaluated for signs of chorioamnionitis. In the absence of these signs, meconium alone is not an indication for intervention.

Question 6

Criteria diagnosis PTL?

Answer 6

Uterine contractions (≥4 every 20 minutes or ≥8 in 60 minutes) plus
●Cervical dilation ≥2 cm or
●Cervical length <20 mm on transvaginal ultrasound or
●Cervical length 20 to <30 mm on transvaginal ultrasound and positive fetal fibronectin

Question 7

Can Augmentin be used as a latency antibiotic?

Answer 7

Amoxicillin–clavulanic acid has been associated with increased rates of necrotizing enterocolitis and is not recommended

Question 8

2 possible regimens for latency antibiotics?

Answer 8

IV ampicillin (2 g every 6 hours) and erythromycin (250 mg every 6 hours) for 48 hours followed by oral amoxicillin (250 mg every 8 hours) and erythromycin base (333 mg every 8 hours) for 5 days
or (substitute for erythro) azithromycin 500mg IV for 2 days, followed by azithromycin 500mg PO x 5 days

Question 9

What does amnisure test for?

Answer 9

Placenta alpha microglobulin-1 (PAM-G)

Question 10

Definition periviable birth?

Answer 10

20-25 6/7 weeks GA