Premature Rupture Of Membranes And Labor Flashcards
Occurs 37 weeks or after 37 weeks AOG
Pregnancy is already TERM
Premature Rupture of Membranes
Occurs before 37 weeks AOG
Preterm Prelabor Rupture of Membranes
PPROM/PROM pathophysiology
Ascending infection due to deciduitis, chorioamnionitis, or fetal infection
Collagenases, mucinases, and proteases produced by vaginal microorganisms
History of watery vaginal discharge
Confirmed on sterile speculum examination
Clinical diagnosis
PPROM/PROM
Amniotic fluid pH
Alkaline
Amniotic fluid pool on the posterior vaginal fornix turns yellow nitrazine into
Blue
Nitrazine test
Amniotic fluid turns red litmus paper to
Blue
Litmus paper test
Indicative of leakage of amniotic fluid into the vaginal canal
Positive ferning patrern on microscopy
Content of amniotic fluid that brings about the crystalization pattern
Na chloride
Ferning pattern on microscopy
PROM
Management of PROM
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
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
Augmentation of labor
Indications for Labor induction
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
C/I for Induction of labor
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
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
Status of membrane
Bishop score
Dilatation Effacement Station Consistency Position
A Bishop score considered favorable for successful vaginal birth
9 or more
The likelihood that the cervix will respond to your induction is very good
Implantation of the placenta in the lower uterine cavity so that the placenta presents ahead of the baby
Placenta previa
Blood bessel coursing through the membrane that is covering the fetal head
Vasa previa
Done if membrane is intact
Use of pharmacologic means to soften, efface or dilate cervix to increase likelihood of a vaginal delivery
Cervical ripening
Mechanical method of cervical ripening
Apply mechanical pressure to increase release of PGE
Transcervical foley catheter
Hygroscopic cervical dilator (laminaria) seaweed that inc cervical diameter by absorbing cervical fluid
Advantages of mechanical method
It can be withdrawn easily
It has lower incidence of uterine tachysystole (frequent uterine contraction)?
It had lower cost
Pharmacologic method of inducing labor
Effective for cervical ripening and inducing labor for women with unfavorable cervices
Prostglandin E2 (Dinoprostone)
Prostaglandin E2 Dinoprostone SE
High incidence of tachysystole
Methods of inducing labor
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
Complications of labor induction
Chorioamnionitis
Rupture of prior uterine incision
Uterine atony
Prophylaxis in mothers who present with PROM
Latency >12 hours
Lower rates of chorioamnionitis 51%
Endometritis 88%
Penicillin G 5 M IV
Ampicillin 2g IV
Cefazolin 2g IV
Clindamycin 900mg IV
Vancomycin 1g IV
PROM prophylaxis is done against?
Group B streptococcus
Clinical diagnosis of Intra-amniotic infection
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
Chorioamnionitis is confirmed by
histopathologic report
Upward migration of cervicovaginal flora
May involve placenta and membranes, fetus, amniotic fluid and umbilical cord
Chorioamnionitis
Antimicrobial Choice for Chorioamnionitis
Ampicillin 2g IV + gentamycin 2mg/kg IV
After CS, add
Clindamycin 900mg
Metronidazole 500mg
for anaerobes
Indications for CS
Dystocia
Chorioamnionitis
Non-reassuring fetal heart pattern
Failed induction of labor
Failed induction of labor is diagnosed when
No change in cervical dilatation observed more than 12-18 hours of induction
No progression to active phase
Most common indication for induction of labor
Postdatism
In what method of induction is the occurence of hyperstimulation less likely?
a. Misoprostol
b. Oxytocin
c. Transcervical balloon
d. Vaginal prostaglandin
Transcervical balloon
Most important element of Bishop score that predicts successful vaginal delivery
Dilatation
