PROM and chorioamnionitis and postpartum hemorrhage Flashcards by Amanda Beach

risks for preterm premature rupture of uterine membranes

previous PROM, preterm labor, vaginal uteral infections, smoking, mechanical stress, GU tract infections, antepartum bleeding

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tests to see if membranes have ruptured

nitrazine and fern test(amnionitc fluid detection)

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need to rule out what for pprom

urinary incontinence, vaginal discharge, perspiration

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when is PPROM

PROM before 37 weeks gestation

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what is mid trimester PROM

PROM 14-26 weeks gestation

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women with PPROM have increased risk of what

placental abruption
umbilical cord prolapse
pulmonary hypoplasia

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Tx PPROM

delivery asap

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when do we give antibiotics for those with PPROM

24-32 weeks

>32 weeks but <34 weeks

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what antibiotic is used in PPROM? for what pathogen?

ampicillin IV

group B strep

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what steroid is given to mom if PPROM

bethamethasone for lung maturity

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what are tocolytics

delay delivery for 48 hours

Mg sulfate

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side effects Mg sulfate

HA flushing, fatigue, diplopia, DTRs

respiratory depression and cardiac arrest at toxic levels

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what antibiotic is given for chlamydia tachomatis

azithromycin

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if penicillin allergy in mom with PPROM what is given

clinda or genta. or cefazolin and cephalexin

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mother with difficult labor
temperature rises and foul odor present
tachycardia
Dx? and Tx?

chorioamnionitis

gentamycin, clinda or vanco

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what is chorioamnionitis

infection of amniotic fluid, membranes, placenta or decidua

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chorioamnionitis is associated with what complications

early neonatal sepsis and penumonia

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what is a common cause of transplacental infection

listeria monocytogenes

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what procedures could increase risk of chorioamnionitis

amniocentesis, chorionic villus sampling, fetal surgery

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risk factors for chorioamnionitis

prolonged labor, prolonged membrane rupture
multiple digital vaginal examinations
nulliparity
previous IAI
meconium stained amniotic fluid,
internal fetal or uterine monitoring
presence of genital tract pathogens
alcohol
tobacco
PROM

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clinical presentation of chorioamnionitis

fever
uterine tenderness
maternal tachy
fetal tachy
purulent or foul amniotic fluid
maternal leukocytosis

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risks with labor if have chorioamnionitis

uterine atony
postpartum hemorrhage
endometritis

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how can chorioamnionitis affect contractions

dysfunctional myometrial contractility from inflammation

risks if C section with chorioamnionitis

wound infection, endomyometritis

venous thrombosis

what is ddx for chorioamnionitis

pyelonephritis, influenza, appendicitis, pneumonia

most specific documentation for intraamnionic infection

culture of amniotic fluid

standard Tx for chorioamnionitis

ampicillin 2 g IV q 6 hours | gentamycin 1.5mg/kg q8hr

what to use for Tx in chorioamnionitis when patient has penicillin allergy

vanco

causes of uterine rupture related to pregnancy

chorioamnionitis abruptio placentae rupture of gravid uterus

causes of uterine rupture uncrelated to pregnancy

torsion ovarian cyst or rupture strangulated hernia, intestinal obstruction renal colic, acute appendicitis

anatomical sites of uterine rupture

anterior left transverse, lateral, fundal, combination

associations of prio births with uterine rupture

previous c section previous uterine surgery cervical cerclage in place

risk factors uterine rupture

``` previous uterine surgery use of uterotonic drugs instrument assisted delivery prolonged and obstructed labor early pregnancy in young immature girls malnutrition tradition (female circumcision) ```

initial care of uterine rupture

resuscitation with crystalloid fluids, blood products gastric decompression urinary catheterization broad spectrum antibiotics

what laparotomy techniques are used for uterine rupture

repaire w/ or w/o tubal ligation | TAH

post op for uterine rupture

transfusion, bladder rest, wound care, antibiotics counseling monitor for obstetrical fistula

significant bleeding in 31 wk pregnant woman some contractions, no abdominal pain, no recent trauma, mass in abdomen mobile nontender ddx?

``` placenta previa placenta abruption displacement cervical mucus plug PROM cervicitis vaginitis/vulvovaginitis ```

painless bleeding in third trimester, imaging?

transvaginal US

hemabate is used for what

stop bleeding

what is placenta previa

placental tissue over or adjacent to os

what is marginal placenta previa

edge of placenta is at margin of internal os

what is low lying placenta

placenta is implanted in lower uterin segment and does not reach os but is close

what is vasa previa

fetal vessels present at cervical os

risk factors placenta previa

``` previous one previous c section multiple gestation multiparity advanced maternal age infertility Tx previous abortion previous intrauterine surgical procedure maternal smoking maternal cocaine use male fetus non-white race ```

tx asymptomatic previa

monitor with US as outpatient, avoid strenuous exercise, planned CS for delivery

Tx bleeding previa

potential EM | hospitalize for monitoring, CS if hemorrhage

when is vaginal delivery attempted in placenta previa

if placental edge is > 10 mm from internal os due to lower risk of hemorrhage during labor

what is too much blood loss in vaginal delivery? CS?

>500mL vaginal | >1000 mL CS

what are the 4 Ts of postpartum hemorrhage

tone trauma tissue thrombus

what is tone in postpartum hemorrhage

no contraciton, sprial arterioles and decidual vv continue to bleed

Tx of atony in postpartum hemorrhage

massage pitocin and cytotec methergine or hemabate

methergine should not be used to stop bleeding in what patients

HTN

hemabate should not be used to stop bleeding in what patients

asthma

causes of PPH from trauma

``` lacerations (forceps or extractors) uterine inversion (improper management in 3rd stage of labor) ```

Tx if uterus is unable to contract and involute around retained placental tissue mass

manual removal | dilation and curettage

what type of thombi can cause postpartum hemorrhage

ITP platelets) amnionic fluid embolus vwDisease

Tx for thrombi causing post partum hemorrhage

coagulation studies