Premature Rupture Of Membranes And Labor

Question 1

Occurs 37 weeks or after 37 weeks AOG

Pregnancy is already TERM

Answer 1

Premature Rupture of Membranes

Question 2

Occurs before 37 weeks AOG

Answer 2

Preterm Prelabor Rupture of Membranes

Question 3

PPROM/PROM pathophysiology

Answer 3

Ascending infection due to deciduitis, chorioamnionitis, or fetal infection
Collagenases, mucinases, and proteases produced by vaginal microorganisms

Question 4

History of watery vaginal discharge
Confirmed on sterile speculum examination

Clinical diagnosis

Answer 4

PPROM/PROM

Question 5

Amniotic fluid pH

Answer 5

Alkaline

Question 6

Amniotic fluid pool on the posterior vaginal fornix turns yellow nitrazine into

Answer 6

Blue

Nitrazine test

Question 7

Amniotic fluid turns red litmus paper to

Answer 7

Blue

Litmus paper test

Question 8

Indicative of leakage of amniotic fluid into the vaginal canal

Answer 8

Positive ferning patrern on microscopy

Question 9

Content of amniotic fluid that brings about the crystalization pattern

Answer 9

Na chloride

Question 10

Ferning pattern on microscopy

Answer 10

PROM

Question 11

Management of PROM

Answer 11

Expectant
Induction - lower risk of chorioamnionitis, endometritis, NICU and neonatal morbidity

Do at the time of diagnosis to decrease incidence of maternal and neonatal complications

Question 12

Labor is already in progress
Labor is not proceeding as expected
Problem in power

Manipulation of power by giving uterotonic agents

Improving quality of contractions in a patient who is already in the active phase of labor

Answer 12

Augmentation of labor

Question 13

Indications for Labor induction

Answer 13

Preeclampsia - high priority
Maternal disease unresponsive to treatment
Significant but stable antepartum hemorrhage
Chorioamnionitis
Suspected fetal compromise
Term PROM

Post term 
Diabetes
IUGR
Oligohydramnios
GHTN
IUFD

Question 14

C/I for Induction of labor

Answer 14

Placenta previa
Vasa previa 
Malpresentation - breech, transverse lie 
Prior classical or inverted T uterine incision - prone to rupture since incision done on active segment 
Significant or prior uterine surgery
Active genital herpes
Pelvic structural abnormality 
Invasive cervical CA
History of uterine rupture

Question 15

Which IE finding is not relevant in assessing favorability of the cervix to respond to induction of labor?

a. Cervical dilatation
b. Cervical effacement
c. Station of presenting part
d. Status of the membrane

Answer 15

Status of membrane

Question 16

Bishop score

Answer 16

Dilatation
Effacement
Station
Consistency
Position

Question 17

A Bishop score considered favorable for successful vaginal birth

Answer 17

9 or more

The likelihood that the cervix will respond to your induction is very good

Question 18

Implantation of the placenta in the lower uterine cavity so that the placenta presents ahead of the baby

Answer 18

Placenta previa

Question 19

Blood bessel coursing through the membrane that is covering the fetal head

Answer 19

Vasa previa

Question 20

Done if membrane is intact

Use of pharmacologic means to soften, efface or dilate cervix to increase likelihood of a vaginal delivery

Answer 20

Cervical ripening

Question 21

Mechanical method of cervical ripening

Answer 21

Apply mechanical pressure to increase release of PGE

Transcervical foley catheter
Hygroscopic cervical dilator (laminaria) seaweed that inc cervical diameter by absorbing cervical fluid

Question 22

Advantages of mechanical method

Answer 22

It can be withdrawn easily
It has lower incidence of uterine tachysystole (frequent uterine contraction)?
It had lower cost

Question 23

Pharmacologic method of inducing labor

Effective for cervical ripening and inducing labor for women with unfavorable cervices

Answer 23

Prostglandin E2 (Dinoprostone)

Question 24

Prostaglandin E2 Dinoprostone SE

Answer 24

High incidence of tachysystole

Question 25

Methods of inducing labor

Answer 25

Nipple stimulation - oxytocin release which would stimulate uterine contractions

Membrane stripping - separating membrane from uterine cavity, increase secretion of prostaglandin

Amniotomy - increase secretion of prostaglandin, uterine contractions become regular

Question 26

Complications of labor induction

Answer 26

Chorioamnionitis
Rupture of prior uterine incision
Uterine atony

Question 27

Prophylaxis in mothers who present with PROM

Latency >12 hours
Lower rates of chorioamnionitis 51%
Endometritis 88%

Answer 27

Penicillin G 5 M IV
Ampicillin 2g IV

Cefazolin 2g IV
Clindamycin 900mg IV
Vancomycin 1g IV

Question 28

PROM prophylaxis is done against?

Answer 28

Group B streptococcus

Question 29

Clinical diagnosis of Intra-amniotic infection

Answer 29

Maternal fever >/= 38 100.4

and at least two

Maternal leukocytosis >15000
Maternal tachycardia >100 
Fetal tachycardia >160
Uterine tenderness 
Foul odor of amniotic fluid or vaginal secretions

Question 30

Chorioamnionitis is confirmed by

Answer 30

histopathologic report

Question 31

Upward migration of cervicovaginal flora

May involve placenta and membranes, fetus, amniotic fluid and umbilical cord

Answer 31

Chorioamnionitis

Question 32

Antimicrobial Choice for Chorioamnionitis

Answer 32

Ampicillin 2g IV + gentamycin 2mg/kg IV

After CS, add

Clindamycin 900mg
Metronidazole 500mg
for anaerobes

Question 33

Indications for CS

Answer 33

Dystocia
Chorioamnionitis
Non-reassuring fetal heart pattern
Failed induction of labor

Question 34

Failed induction of labor is diagnosed when

Answer 34

No change in cervical dilatation observed more than 12-18 hours of induction

No progression to active phase

Question 35

Most common indication for induction of labor

Answer 35

Postdatism

Question 36

In what method of induction is the occurence of hyperstimulation less likely?

a. Misoprostol
b. Oxytocin
c. Transcervical balloon
d. Vaginal prostaglandin

Answer 36

Transcervical balloon

Question 37

Most important element of Bishop score that predicts successful vaginal delivery

Answer 37

Dilatation