PROM, Induction, & Augmentation Of Labor Flashcards
What are the significance of rupture of membranes?
Umbilical cord prolapse = can occur if the presenting part is not fixed in the pelvis
Beginning of labor
Intrauterine & neonatal infection = if deliveryis delayed
What is the diff betw PROM & PPROM?
PROM (Prelabor Rupture of Membranes)
- rupture of membrane occurs from 37 weeks of gestation onwards
PPROM (Preterm Prelabor Rupture of Membranes)
- rupture of membrane occurs <37 wks of gestation
How do u categorize if rupture of membrane is prolonged?
If it persists >24 hrs & prior to onset of labor
What is the most common identifiable risk factor for PROM?
Genital tract infection
What enzymes can weaken the amnion and chorion brough by microorganisms that ascend the vagina?
Collagenases
Mucinases
Proteases
What are the predisposing factors of PROM?
Intrauterine infection
Oxidative stress-induced DNA damage
Premature cellular senscence
What are the risk factors for PROM?
Low socio-economic status
BMI <19.8
Nutritional deficiencies
Cigarette smoking
1 risk of recurrence in subsequent pregnancy
How do you diagnose PROM?
Water vaginal discharge
confirmed on sterile speculum exam
During sterile speculum examination, what should u take note upon looking at the cervix to diagnose PROM?
Visual pooling of fluid in the poterior vaginal fornix or leakage of fluid in the posterior vaginal fornix or leakage of fluid from the cervical os
How do u differentiate amniotic fluid from urine?
Urine = can be controlled ang leakage
Amniotic fluid = continuous or intermittent and uncontrollable
What is a confirmatory test for ruptured membranes?
Ferning test
(+) ferning = positive result
What are other proteins used to detect PROM?
AFP
Placental alpha microglobulin 1
Insulin factor growth binding protein-1
What is the meaning of augmentation of labor?
Enhancement of spontaneous contractions considered inadequate beause of failed cervical dilation & poir fetal descent
What is the importance of induction of labor?
Benefits to either mother or fetus outweighs thoes of pregnancy continuation (>96 hrs ff membrane rupture)
Lower risk of chorioamnionitis, endomitriosis, NICU admission
Fewer intrapartum & postpartum infection
What are indications of induction of labor?
Membrnae rupture without labor
Gestational hypertension
Oligohydramnios
Non-reassuring fetal status
Post-term pregnancy
Maternal medical conditions: Chronic HTN, DM
What are maternal CIs to induction & augmentation?
Abnormally impalnted placentas (vasa previa, placenta previa)
Prior uterine incision
COntracted or distorted pelvic anatomy
Active genital herpes infection
Cervical cancer
What are fetal CIs of induction & augmentation?
Appreciable macrosomia
Severe hydrocephalus
Malpresentation
Non-reassuring fetal status
What are the risks of underoing induction or augmentation of labor?
Chorioamnionitis
Uterine rupture
Postpartum hemorrhage from uterine atony
Comparable or lower CS rates in induction of labor vs spontaneous labor
What are the pre-induction assessment questions?
- Is there a compelling indication for induction?
- Is the AOG accurate?
- Is the fetal presentation, size and well being appropriate for induction
- Is the maternal pelvis adequate for vaginal delivery?
- What is the likelihood that the cervix will respond to induction?
What is elective labor induciton?
Initiation of labor for convenience in a person with a term pregnancy who doesnt medically need the intervention
What is the AOG for elective inuction?
Not <39 wks of pregnancy
What are logistic reasons for elective labor induction?
A risk for rapid labor
Woman who lives a long distanec from the hospital
Psychosocial indications
What are factors affecting success of induction/?
Younger age
Multiparity
BMI <30
Favorable cervix
Birthweght <3500g
What are the 5 parameters of the Bishop score?
Dilation = most imoprtant predictor
Effacement
Station of the fetal head
Consistency
Position
What is the cervical favorability according to the bishop scoring system?
Favorable cervix = bishop score > 8
Unfavorable cervix = bishop score <6
What are the means used to soften, efface, or dilate the cervix in order to increase likelihood of vaginal delivery?
Mechanical and pharmacological means
What is a catheter that acts as a mechanical dilator but results in higher infection rates?
Transcervical FOley catheter insertion
What type of mechanical means is used more frequently in clinical practice for cervical ripening?
Hygroscopic cervical dilator (laminaria)
What are the diff pharmacological options for cervical ripening?
Prostaglandin E2 = Dinoprostone gel, Dinoprostone (Cervidil)
Prostaglandin E1 = Misoprostol
Why is dinoprostone no longer used for cervical ripening?
Uterine hypertonus
Hyperstimulation
Hypercontractility
What are CIs of nitric oxide as medication for cervical ripening?
More headaches
Nausea
Vomiting
What are the complications of labor induction?
Cesarean delivery
Chorioamnionitis
Uterine rupture
Postpartum hemorrhage from uterine atony
What are the recommedations for women with unfavorable cervixes?
Preinduction cervical ripening INC the likelihood of a successful induction
What are the diff methods of induction & augmentation?
Oxytocin
Prostaglandins
Mechanical mthds: membrane stripping
Amniotomy
Nipple stimulation
What is the use of oxytocin?
After delivery, thi sis used to contract the uterus for augmentation and induction
1mL vial (10 unital of oxytocin)
What is amniotomy?
Artificially rupturing of the membrane by uteirne contractions through the release of prostanglanding & allows ID of meconium staining of the amniotic fluid
What is the most frequent side effect of oxytocin?
Tachysystole (>5 contractions in 10 minutes)
What prophylaxis should be given in women with latency longer than 12 hrs?
Group B streptococcus prophylaxis in term PROM
- significantly lowers rates of chorioamnionitis
How do u detect intraamniotic infection?
Maternal temps >39 or equal to that
1 additional clinical risk factor is present
- low parity
- multiple digital exams
- internal uterine and fetal monitors
Meconium-stained amniotic fluid
+ certain genital tract pathogens
Maternal leukocytosis (>15,000 cells/mm3)
Maternal tachycardia (>100bpm)
Fetal tachycardia (>160bpm)
How to confirm intraamniotic infection?
+ histopathologic dx of CHorioamnionitis
Upward migration of cervicovaginal flora = most common
What are indications for CS
Dystocia
Non-reassuring fetal heart pattern
Failed induction of labor
Aside from IAI or chorioamnionitis: variable deceleration of fetal heart rate
