UW ROM + PROM + PPROM 02-20 (1) Flashcards
UW table. PPROM. definition?
Membrane rupture at <37 weeks prior to labor onset.
UW table. PPROM. risk factors ?3
Prior PPROM (eg due to polyhydramnios = cause overdistension)
Genitourinary infections (ASYMPTOMATIC BACTERIURIA, BACTERIAL VAGINOSIS)
Antepartum bleeding
UW table. PPROM. Dx?3
vaginal pooling or fluid from cervix
nitrazine-positive (blue) fluid
ferning on microscopy
UW table. PPROM. Mx < 34 weeks (reassuring)? 2
Latency antibiotics
Corticosteroids
UW table. PPROM. Mx < 34 weeks (NONreassuring)?
Delivery
UW table. PPROM. Mx >=34 weeks?
delivery
UW table. PPROM. Complications? 4
Preterm labor
Intraamniotic infection
Placental abruption
Umbilical cord prolapse
UW. PPROM. source of infection
Genitourinary tract
UW. PPROM. why infection incr. risk?
As bacteria spreads to the uterus, the intrauterine bacterial enzymatic activity may cause contractions (by stimulating prostaglandin release)
OR
increase membrane fragility (by degrading collagen or activating inflammatory cytokines), resulting in either preterm labor or PPROM.
UW. PPROM. How to prevent infection?
all patients require urine culture screening at their initial prenatal visit, and high-risk patients (eg, age <25) undergo STDs screening.
Those who screen positive require timely treatment and repeat cultures after treatment (ie, test of cure) to reduce risks of persistent infection.
UW. PPROM. kiti ats. Multiparity increase what?
for postpartum hemorrhage, not PPROM.
UW. PPROM. kiti ats. what about age, what incr. risk?
Extremes of maternal age (eg, age <17 or >35) are associated with preterm labor and PPROM; this patient is age 30
UW. PPROM. kiti ats. Prior cesarean risk?
increases the risk of abnormal placentation (eg, placenta accreta), not PPROM
UW. PPROM. kiti ats. Previous spontaneous abortion risk?
is not associated with PPROM or preterm delivery.
UW table. PPROM. kiti ats.
Previous cervical surgeries or uterine procedures (eg, multiple dilations and evacuations) are associated with preterm delivery.
.
UW. PPROM. kiti ats, placenta previa risk?
Cab have antepartum bleeding with an increased risk of PPROM, likely due to blood causing inflammation and focal weakening of the fetal membranes.
UW. PPROM. Mx algorithm.
Rupture membrane –> what evaluate?
WEEKS!!!!!
<34 w
and
34 to <37 w
UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> clinical condition evaluation?
Uncomplicated OR infection, fetal/maternal compromise
UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> uncomplicated –> Mx? 4
Expectant Mx
Latency antibiotics (eg empicillin and azithromycin)
Corticosteroids
Fetal surveilance
UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> infection, fetal/maternal compromise. Mx?4
Delivery
Intraamniotic infection Tx (eg ampic and gentamycin)
Corticosteroids
Magnesium if <32 w
UW. PPROM. Mx algorithm.
Rupture membrane —> 34 w to <37w –> Mx?3
Delivery
GBS prophylaxis (eg pinicillin G)
+/- corticosteroids
UW. PPROM.
Patients with PPROM at <34 weeks gestation are at high risk for prematurity-related fetal morbidity and mortality; therefore, expectant management is aimed at promoting in utero fetal development and consists of the following:3?
- Prophylactic latency antibiotics
- Antenatal corticosteroids (eg, betamethasone) -> to decr. NRDS
- fetal surveillance (eg, nonstress test, fetal growth ultrasound examination).
UW. PPROM.
PPROM is commonly due to a subclinical intraamniotic infection, and latency antibiotics prevent the infection from becoming fulminant, thereby increasing the time interval between membrane rupture and delivery (ie, prolonged latency).
corticosteroids (eg, betamethasone): These are administered to promote fetal lung maturation (eg, pneumocyte development, surfactant release), thereby reducing neonatal morbidity and mortality.
UW. case. PPROM. When is indicated delivery?
Delivery is indicated if there are signs of intraamniotic infection
or deteriorating fetal/maternal status
or if the pregnancy has reached 34 weeks gestation.
Patients with PPROM require delivery at 34 weeks gestation (when risk of complications exceeds neonatal risks associated with preterm delivery) or earlier in the event of complications (eg, placental abruption).
UW. case. PPROM. What about amnioinfusion? zymejau kai buvo teisingas ats kad reik antibiotiku.
Amnioinfusion replaces leaking amniotic fluid with normal saline. Although this patient has oligohydramnios (ie, deepest vertical pocket <2 cm) due to PPROM, amnioinfusion for PPROM in the third trimester has not been shown to improve fetal outcomes.
Amnioinfusion would be indicated for recurrent variable decelerations (caused by cord compression), which this patient does not have.
UW. case. PPROM. why is given Mg < 32 w?
Magnesium sulfate is given for fetal neuroprotection (ie, cerebral palsy risk reduction) for preterm deliveries at <32 weeks gestation.
if fetus 33 weeks - dont give
UW. case. PPROM. what about tocolysis?
Tocolysis (eg, nifedipine) halts all contractions.
It is commonly administered to patients in spontaneous early preterm labor (<34 weeks gestation without ROM) to delay delivery while corticosteroids take effect.
Tocolysis is typically not administered for PPROM because monitoring for increasing contractions is essential for the early detection and management of life-threatening PPROM complications (eg, intraamniotic infection, placental abruption).
UW. 1 ROM case. 38w + clear fluid. AFI 4 cm –> Why?
oligohydramnios, an amniotic fluid index of ≤5 cm
UW. 1 ROM case. Origin of oligohydramnios in first trimester?
Early-gestation oligohydramnios is concerning for fetal etiologies (eg, aneuploidy, renal agenesis, posterior urethral valves) because amniotic fluid volume is dependent on normal fetal urine production.
UW. 1 ROM case. Origin of oligohydramnios in second-third trimester?
deu to uteroplacental insufficiency (with concomitant fetal growth restriction)
or
maternal causes, such as dehydration or rupture of membranes (with normal fetal growth).
UW. 1 ROM case. jeigu at term (case was 38) + AFI 4 cm, reason?
spontaneous rupture of membranes.
UW. 1 ROM case. volume of fluid?
typically presents as a sudden gush of fluid, patients can have a subclinical presentation with slow leakage occurring over days, as in this patient with increased clear vaginal discharge.
UW. 1 ROM case. if ROM occurs, what evaluation?
even asymptomatic patients with oligohydramnios require speculum examination to evaluate for membrane rupture.
UW. 1 ROM case. buvo kitas variantas kad third-trimester AFI of ≤5 cm is always abnormal. Jo, bet jeigu yra symptoms of ROM + normal term = tai oligo yra nes jau ROM
.
UW. 1 ROM case. oligo gali but hipovolemijos priezastis 2-3 trimestruose. in case buvo pamineti GI simptomai pries pora dienu!!!!
.
UW. 1 ROM case. kada buna amnio peak? AFI
AFI varies with gestational age and peaks at 30-32 weeks gestation before gradually declining
The most common cause of oligohydramnios (amniotic fluid index ≤5 cm) at term gestation??
Spontaneous rupture of membranes. Patients typically have normal fetal growth and leakage of clear vaginal fluid.
