Therapeutic Management: Polyhydramnios & OligoHydramnios & Preterm Labor & Premature Rupture of Membranes & Ruptured Uterus

Question 1

Oligohydramnios: Therapeutic Management

Answer 1

a. Evaluate the fetus for signs of post-maturity, congenital anomalies, and respiratory difficulty

b. During amnioinfusion, assess the woman’s vital signs and contraction status, monitor fetal heart rate throughout the
procedure

c. Provide comfort measures in bedding and perineal care

Question 2

Oligohydramnios: Medical Management

Answer 2

a. Transabdominal Amnioinfusion
- 200 - 300 ml sterile saline is instilled
- to keep the amniotic fluid at the normal volume to avoid complications for the mother and the fetus

b. Fetal Vesicoamniotic shunt relieving pressure on the kidneys and improving oligohydramnios

Question 3

Polyhydramnios: Therapeutic Management

Answer 3

a. Promote maintaining bed rest which helps increase
uteroplacental circulation and reduces pressure on cervix

b. Teach a woman to report any signs of ruptured membranes or uterine contractions

c. Encourage to eat a high-fiber diet to avoid constipation

d. Assess vital signs and lower extremity edema frequently

Question 4

Polyhydramnios: Medical Management

Answer 4

a. Amniocentesis
o Amniocentesis or artificial rupture of the membranes is done to reduce the fluid and the pressure, removal of
fluid by amniocentesis is only transiently effective
o Abdominally or through the cervix
o Dye dilution technique: volume of dye injected into amniotic cavity via sterile needle under ultrasound guidance

b. Tocolytic Therapy
o Prostaglandin synthesis inhibitor (indomethacin) is a
noninvasive treatment used to decrease amniotic fluid
volume by decreasing fetal urinary output but may
cause premature closure of the fetal ductus arteriosus

c. Amnioreduction
- type of amniocentesis

d. Prostaglandin Synthase inhibitors
- stimulates ADH to decrease urine production

Question 5

Premature Rupture of Membranes: Medications

Answer 5

a. Betamethasone (Celestone) or Dexamethasone (Decadron) o Given to stimulate the lungs and accelerate fetal lung
maturity thereby decreasing chance of respiratory
distress syndrome
- Lasts for about 7 days and need to repeat

b. Azithromycin + Ampicillin/Amoxicillin
- Prevent IAI & GBS

c. Magnesium Sulfate
- neuroprotection against cerebral palsy

Question 6

Preterm Labor: Therapeutic Management

Answer 6

a. Tocolytics: used to stop or arrest labor by inhibiting uterine contractions

1. Yutopar (Ritodrine)
   - toxic effect:pulmonary edema
   - antidote: Inderal
2. Brethine (Terbutaline Sulfate)
   - toxic effect:pulmonary edema
   - antidote: Inderal
3. Magnesium Sulfate
   - blocks acetylcholine
   - IV infusion pump
   - loading dose: 4-6 g in 100 ml over 20 minutes
   - maintenance dose: 1-4 g per hour

b. Calcium channel blocker: Decreases smooth muscle contraction by blocking the slow calcium channels at cell surface

1. Nifedipine

c. Prostaglandin Synthesis Inhibitor: Inhibits prostaglandin synthesis thus reducing uterine contractions

1. Indomethacin (Indocin)
   - used for <32 weeks gestation, not given more than 72 hours
   - not widely used to treat preterm labor

d. Accelerating Fetal Lung Maturity

1. Betamethasone (Celestone)
   - stimulate production of surfactant

Question 7

Ruptured Uterus: Therapeutic Management

Answer 7

a. Stripping the Membranes
- With a gloved finger, the amniotic membranes lying
against the lower uterine segment are separated. This
causes release of prostaglandins that stimulate uterine
contractions

b. Pitocin (Oxytocin) Infusion
- for induction and augmentation

Other Methods of Induction
a. ambulation
b. Nipple Stimulation
c. Enema
d. Herbs
e. Insertion of balloon catheter