UW ROM + PROM + PPROM 03-24 (2)

Question 1

UW table. PPROM. definition?

Answer 1

Membrane rupture at <37 weeks prior to labor onset.

Question 2

UW table. PPROM. risk factors ?3

Answer 2

Prior PPROM (eg due to polyhydramnios = cause overdistension)
Genitourinary infections (ASYMPTOMATIC BACTERIURIA, BACTERIAL VAGINOSIS)
Antepartum bleeding

Question 3

UW table. PPROM. Dx?3

Answer 3

vaginal pooling or fluid from cervix
nitrazine-positive (blue) fluid
ferning on microscopy

Question 4

UW table. PPROM. Mx < 34 weeks (reassuring)? 2

Answer 4

Latency antibiotics
Corticosteroids

Question 5

UW table. PPROM. Mx < 34 weeks (NONreassuring)?

Answer 5

Delivery

Question 6

UW table. PPROM. Mx >=34 weeks?

Answer 6

delivery

Question 7

UW table. PPROM. Complications? 4

Answer 7

Preterm labor
Intraamniotic infection
Placental abruption
Umbilical cord prolapse

Question 8

UW. PPROM. source of infection

Answer 8

Genitourinary tract

Question 9

UW. PPROM. why infection incr. risk?

Answer 9

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.

Question 10

UW. PPROM. How to prevent infection?

Answer 10

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.

Question 11

UW. PPROM. kiti ats. Multiparity increase what?

Answer 11

for postpartum hemorrhage, not PPROM.

Question 12

UW. PPROM. kiti ats. what about age, what incr. risk?

Answer 12

Extremes of maternal age (eg, age <17 or >35) are associated with preterm labor and PPROM; this patient is age 30

Question 13

UW. PPROM. kiti ats. Prior cesarean risk?

Answer 13

increases the risk of abnormal placentation (eg, placenta accreta), not PPROM

Question 14

UW. PPROM. kiti ats. Previous spontaneous abortion risk?

Answer 14

is not associated with PPROM or preterm delivery.

Question 14

UW table. PPROM. kiti ats.
Previous cervical surgeries or uterine procedures (eg, multiple dilations and evacuations) are associated with preterm delivery.

Answer 14

.

Question 15

UW. PPROM. kiti ats, placenta previa risk?

Answer 15

Cab have antepartum bleeding with an increased risk of PPROM, likely due to blood causing inflammation and focal weakening of the fetal membranes.

Question 16

UW. PPROM. Mx algorithm.
Rupture membrane –> what evaluate?

Answer 16

WEEKS!!!!!
<34 w
and
34 to <37 w

Question 17

UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> clinical condition evaluation?

Answer 17

Uncomplicated OR infection, fetal/maternal compromise

Question 18

UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> uncomplicated –> Mx? 4

Answer 18

Expectant Mx
Latency antibiotics (eg empicillin and azithromycin)
Corticosteroids
Fetal surveilance

Question 19

UW. PPROM. Mx algorithm.
Rupture membrane —> <34 w –> infection, fetal/maternal compromise. Mx?4

Answer 19

Delivery
Intraamniotic infection Tx (eg ampic and gentamycin)
Corticosteroids
Magnesium if <32 w

Question 20

UW. PPROM. Mx algorithm.
Rupture membrane —> 34 w to <37w –> Mx?3

Answer 20

Delivery
GBS prophylaxis (eg pinicillin G)
+/- corticosteroids

Question 21

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?

Answer 21

• Prophylactic latency antibiotics
• Antenatal corticosteroids (eg, betamethasone) -> to decr. NRDS
• fetal surveillance (eg, nonstress test, fetal growth ultrasound examination).

Question 22

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).

Answer 22

corticosteroids (eg, betamethasone): These are administered to promote fetal lung maturation (eg, pneumocyte development, surfactant release), thereby reducing neonatal morbidity and mortality.

Question 23

UW. case. PPROM. When is indicated delivery?

Answer 23

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).

Question 24

UW. case. PPROM. What about amnioinfusion? zymejau kai buvo teisingas ats kad reik antibiotiku.

Answer 24

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.

Question 25

UW. case. PPROM. why is given Mg < 32 w?

Answer 25

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

Question 26

UW. case. PPROM. what about tocolysis?

Answer 26

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).

Question 27

UW. 1 ROM case. 38w + clear fluid. AFI 4 cm --> Why?

Answer 27

oligohydramnios, an amniotic fluid index of ≤5 cm

Question 28

UW. 1 ROM case. Origin of oligohydramnios in first trimester?

Answer 28

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.

Question 29

UW. 1 ROM case. Origin of oligohydramnios in second-third trimester?

Answer 29

deu to uteroplacental insufficiency (with concomitant fetal growth restriction) or maternal causes, such as dehydration or rupture of membranes (with normal fetal growth).

Question 30

UW. 1 ROM case. jeigu at term (case was 38) + AFI 4 cm, reason?

Answer 30

spontaneous rupture of membranes.

Question 31

UW. 1 ROM case. volume of fluid?

Answer 31

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.

Question 32

UW. 1 ROM case. if ROM occurs, what evaluation?

Answer 32

even asymptomatic patients with oligohydramnios require speculum examination to evaluate for membrane rupture.

Question 33

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

Answer 33

.

Question 34

UW. 1 ROM case. oligo gali but hipovolemijos priezastis 2-3 trimestruose. in case buvo pamineti GI simptomai pries pora dienu!!!!

Answer 34

.

Question 35

UW. 1 ROM case. kada buna amnio peak? AFI

Answer 35

AFI varies with gestational age and peaks at 30-32 weeks gestation before gradually declining

Question 36

The most common cause of oligohydramnios (amniotic fluid index ≤5 cm) at term gestation??

Answer 36

Spontaneous rupture of membranes. Patients typically have normal fetal growth and leakage of clear vaginal fluid.