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Year2 Repro exam II > PROM and chorioamnionitis and postpartum hemorrhage > Flashcards

PROM and chorioamnionitis and postpartum hemorrhage Flashcards

1
Q

risks for preterm premature rupture of uterine membranes

A

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

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2
Q

tests to see if membranes have ruptured

A

nitrazine and fern test(amnionitc fluid detection)

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3
Q

need to rule out what for pprom

A

urinary incontinence, vaginal discharge, perspiration

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4
Q

when is PPROM

A

PROM before 37 weeks gestation

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5
Q

what is mid trimester PROM

A

PROM 14-26 weeks gestation

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6
Q

women with PPROM have increased risk of what

A

placental abruption
umbilical cord prolapse
pulmonary hypoplasia

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7
Q

Tx PPROM

A

delivery asap

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8
Q

when do we give antibiotics for those with PPROM

A

24-32 weeks

>32 weeks but <34 weeks

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9
Q

what antibiotic is used in PPROM? for what pathogen?

A

ampicillin IV

group B strep

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10
Q

what steroid is given to mom if PPROM

A

bethamethasone for lung maturity

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11
Q

what are tocolytics

A

delay delivery for 48 hours

Mg sulfate

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12
Q

side effects Mg sulfate

A

HA flushing, fatigue, diplopia, DTRs

respiratory depression and cardiac arrest at toxic levels

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13
Q

what antibiotic is given for chlamydia tachomatis

A

azithromycin

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14
Q

if penicillin allergy in mom with PPROM what is given

A

clinda or genta. or cefazolin and cephalexin

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15
Q

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

A

chorioamnionitis

gentamycin, clinda or vanco

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16
Q

what is chorioamnionitis

A

infection of amniotic fluid, membranes, placenta or decidua

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17
Q

chorioamnionitis is associated with what complications

A

early neonatal sepsis and penumonia

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18
Q

what is a common cause of transplacental infection

A

listeria monocytogenes

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19
Q

what procedures could increase risk of chorioamnionitis

A

amniocentesis, chorionic villus sampling, fetal surgery

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20
Q

risk factors for chorioamnionitis

A 
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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21
Q

clinical presentation of chorioamnionitis

A 
fever
uterine tenderness
maternal tachy
fetal tachy
purulent or foul amniotic fluid
maternal leukocytosis
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22
Q

risks with labor if have chorioamnionitis

A

uterine atony
postpartum hemorrhage
endometritis

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23
Q

how can chorioamnionitis affect contractions

A

dysfunctional myometrial contractility from inflammation

24
Q

risks if C section with chorioamnionitis

A

wound infection, endomyometritis

venous thrombosis

25
Q

what is ddx for chorioamnionitis

A

pyelonephritis, influenza, appendicitis, pneumonia

26
Q

most specific documentation for intraamnionic infection

A

culture of amniotic fluid

27
Q

standard Tx for chorioamnionitis

A

ampicillin 2 g IV q 6 hours

gentamycin 1.5mg/kg q8hr

28
Q

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

A

vanco

29
Q

causes of uterine rupture related to pregnancy

A

chorioamnionitis
abruptio placentae
rupture of gravid uterus

30
Q

causes of uterine rupture uncrelated to pregnancy

A

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

31
Q

anatomical sites of uterine rupture

A

anterior left transverse, lateral, fundal, combination

32
Q

associations of prio births with uterine rupture

A

previous c section
previous uterine surgery
cervical cerclage in place

33
Q

risk factors uterine rupture

A 
previous uterine surgery
use of uterotonic drugs
instrument assisted delivery
prolonged and obstructed labor
early pregnancy in young immature girls
malnutrition
tradition (female circumcision)
34
Q

initial care of uterine rupture

A

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

35
Q

what laparotomy techniques are used for uterine rupture

A

repaire w/ or w/o tubal ligation

TAH

36
Q

post op for uterine rupture

A

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

37
Q

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

A 
placenta previa
placenta abruption
displacement cervical mucus plug
PROM
cervicitis
vaginitis/vulvovaginitis
38
Q

painless bleeding in third trimester, imaging?

A

transvaginal US

39
Q

hemabate is used for what

A

stop bleeding

40
Q

what is placenta previa

A

placental tissue over or adjacent to os

41
Q

what is marginal placenta previa

A

edge of placenta is at margin of internal os

42
Q

what is low lying placenta

A

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

43
Q

what is vasa previa

A

fetal vessels present at cervical os

44
Q

risk factors placenta previa

A 
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
45
Q

tx asymptomatic previa

A

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

46
Q

Tx bleeding previa

A

potential EM

hospitalize for monitoring, CS if hemorrhage

47
Q

when is vaginal delivery attempted in placenta previa

A

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

48
Q

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

A

> 500mL vaginal

>1000 mL CS

49
Q

what are the 4 Ts of postpartum hemorrhage

A

tone
trauma
tissue
thrombus

50
Q

what is tone in postpartum hemorrhage

A

no contraciton, sprial arterioles and decidual vv continue to bleed

51
Q

Tx of atony in postpartum hemorrhage

A

massage
pitocin and cytotec
methergine or hemabate

52
Q

methergine should not be used to stop bleeding in what patients

A

HTN

53
Q

hemabate should not be used to stop bleeding in what patients

A

asthma

54
Q

causes of PPH from trauma

A 
lacerations (forceps or extractors)
uterine inversion (improper management in 3rd stage of labor)
55
Q

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

A

manual removal

dilation and curettage

56
Q

what type of thombi can cause postpartum hemorrhage

A

ITP platelets)
amnionic fluid embolus
vwDisease

57
Q

Tx for thrombi causing post partum hemorrhage

A

coagulation studies

Year2 Repro exam II (19 decks)

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