PROM, chorioamnioitis, uterine rupture Flashcards
PPROM
pre-term (before 37 wks), premature rupture of membrane
how does ruptured membranes change vaginal acidity
more alkalodic
mid trimester PROM
14-26 wks
risks associated with PROM
intrauterine infections
placental abruption
umbilical cord prolapse
pulmonary hypoplsia
PROM 24-32wks
Abx and GBS prophylaxis at delivery
32-34 wks
abx and GBS prophylaxis
> 34wks
GBS prophylaxis begins on admission and continues till delivery
abx for PROM
ampicillin IV once, followed by IV every 6 hours
amoxicillin
azythromycin
tocolytics
delay delivery for 48 hours
magnesium sulfate
IAI
intramniotic infection
chorioaminoitis
IAI
infection of amniotic fluid, membranes, plancta, and or decidua
uncommon methods to infection
transplacental d/t bacteremia (listeria)
amniocentisis
chorionic villus sampling
fetal surgery
risk factors for chorioamnioitis
prolonged labor prolonged membrane rupture multiple digital vaginal exams nullparity previous IAI meconium stained amnion internal fetal or uterine monitoring presence of GI tract pathogens alcohol tabacco PROM
clinical presentation of chorioamnioitis
fever uterine tenderness maternal tachy fetal tachy purulent or foul smelling amniotic fluid maternal leukocytosis
risks of chorioamnioitis
increased risk of labor abnormalities (uterine atony, postpartum hemorrhage, endometritis)
dydfunctional myometrial contractility d/t inflammation
if they have c-section have increased risk for wound infection, endomyometritis, venous thrombosis
Dx chorioamnioitis
culture of amiontic fluid gold standard, but takes days
risk factors for uterine rupture
previous uterine surger uterotonic drugs prolonged and obstructed labor cephalopelvic disproportion breech, brow, and face malpresentation early pregnancy in young girls malnutrition harmful traditional practices (female circumcision)
initial care of uterine rupture
resusciation with crystalloid fluids, blood products
gastric decompression
urinary catherization
broad spectrum abx
laparotomy
repair w/or w/o tubal ligation
total abdominal hysterectomy
post op care of uterine rupture
transfusions, bladder rest, wound care, abx
monitor for obstetrical fistula
