Preterm cervical dilation

Question 1

How do you manage a patient with asymptomatic preterm cervical dilation found on exam?

Answer 1

18 weeks - cerclage, urine/vaginal cx
22 weeks - cerclage, urine/vaginal cx
25 weeks - BMZ, GBS, mag

Question 2

What questions will you ask the patient if she is found to have preterm cervical dilation?

Answer 2

• assess contractions, vaginal discharge, pruritus, dysuria, hematuria, urinary frequency, fever
• med surg history
• ob history
• leep
• genetics

Question 3

How do you manage a patient with symptomatic preterm cervical dilation found on examination?

Answer 3

BMZ, GBS pox, magnesium for neuroprotection

Question 4

How common is intra-amniotic infection present in patients with preterm cervical dilation?

Answer 4

15-35% if ruptured (acog)

11% without rupture, 21-29% pprom

Question 5

When do you recommend amniocentesis in the setting of preterm cervical dilation?

Answer 5

emergency cerclage placement

Question 6

What studies do you send on amniotic fluid to evaluate for intra-amniotic infection?

Answer 6

gram staining, culture for aerobic and anaerobic bacteria, glucose, lactate dehydrogenase, il6, wbc

Question 7

How do you interpret results of amniotic fluid studies for intrauterine infection?

Answer 7

AF glucose less than 14
LDH >400
+ gram positive stain and culture

Question 8

How do you interpret a low glucose in the amniotic fluid?

Answer 8

Low glucose is an indicator of bacteria presence that is consuming the glucose

Question 9

How do you define low glucose in the amniotic fluid?

Answer 9

AF glucose less than 14

Question 10

Why is amniotic fluid glucose low in the setting of intra-amniotic infection?

Answer 10

bacterial consumption

Question 11

which amniotic fluid studies have the greatest sensitivity to detect intra-amniotic infection

Answer 11

culture