Dunn OB/GYN III

Question 1

PPROM

Answer 1

preterm premature rupture of membranes

if before 37 weeks

Question 2

risk of PPROM

Answer 2

pervious PROM
preterm labor
vaginal uteral infection
smoking

Question 3

digital exam

Answer 3

with ruptured membrane

-don’t want to introduce bacteria

Question 4

nitrazine

Answer 4

examine pH

blood and semen - false positive

Question 5

ferning

Answer 5

amniotic fluid

Question 6

33yoF, gush of clear fluid, 30 weeks, nitrazine and ferning positive

Answer 6

PPROM - diagnosis

Question 7

PROM

Answer 7

premature rupture of membranes

spontaneous rupture - prior to onset of labor

Question 8

midterm PROM

Answer 8

14-26 weeks

Question 9

risk factors for PPROM

Answer 9

infection - GI**
previous PPROM
antepartum bleeding
smoking - 2-4x increased
mechanical stress - twins, trauma, polyhydramnios

Question 10

management of PPROM

Answer 10

admit to labor and delivery
-confirm diagnosis

infection or bad fetal status - delivery

stable mother and fetus - hospitalize until delivery
-antenatal corticosteroids, antibiotics, monitor

at 34 weeks - deliver
-check lung maturity

Question 11

1/3 women with PPROM

Answer 11

potential serious intrauterine infections

increased risk for placental abruption, umbilical cord prolapse, pulmonary hypoplasia

Question 12

PPROM 24-32 weeks

Answer 12

antibiotics and group B strep at delivery if indicated

Question 13

32-34 weeks PPROM

Answer 13

antibiotics and group B strep prophylaxis at delivery if indicated

Question 14

> 34 weeks PPROM

Answer 14

group B strep prophylaxis beyun on admission and continued until delivery

Question 15

antibiotics for PPROM

Answer 15

ampicillin 2g IV once, followed by 1g q6hrs

Question 16

steroids and PPROM

Answer 16

only if patient <34 weeks

for fetal lung maturity

Question 17

betamethasone

Answer 17

corticosteroid

for fetal lung maturity

12mg IM daily - 2 doses

Question 18

tocolytics

Answer 18

stop labor
-delay delivery for 48 hours

Mg sulfate

Question 19

magnesium sulfate

Answer 19

decreases uterine tone and contraction - acts as calcium antagonist and membrane stabilizer

watch for headache, flushing, fatigue, diplopia

toxic levels - resp and cardiac arrest

Question 20

group B strep

Answer 20

ampicillin

Question 21

azithromycin

Answer 21

genital mycoplasmas

protect chorioamnionitis and provide chlamydia coverage

Question 22

PCN allergy

Answer 22

cefalozin and cephalexin

or clindamycin and gentamycin

Question 23

intraamniotic infection

Answer 23

chorioamnionitis

infection of amniotic fluid, membranes, placenta, and or decidua

20-40% early neonatal sepsis and pneumonia

cervicovaginal flora migration

membrane rupture - facilitates process

Question 24

transplacental infection

Answer 24

uncommon chorioamnionitis

-listeria monocytogenes

Question 25

other uncommon methods of chorioamnionitis infection

Answer 25

amniocnentesis chorionic villus sampling fetal surgery

Question 26

chorioamnionitis organisms

Answer 26

``` ureaplasma urealyticum gram negative anaerobes mycoplasma hominis bacteroids bivius gardnerella vaginalis group B strep - 15% ```

Question 27

risk fx for chorioamnionitis

Answer 27

``` long labor long membrane rupture digital vaginal exams nulliparity previous meconium in amniotic fluid internal fetal monitoring alcohol tobacco genital tract pathogens PROM ```

Question 28

fever, uterine tenderness, maternal tachy, fetal tachy, purulent amniotic fluid, maternal leukocytosis >12,000

Answer 28

chorioamnionitis

Question 29

fetal tachy

Answer 29

>160

Question 30

risks with chorioamnionitis

Answer 30

labor abnormalities dysfunctional uterine myometrium - inflammation C section - wound infection, endomyometritis, venous thrombosis

Question 31

diagnosis of chorioamnionitis

Answer 31

``` fever maternal leukocytosis maternal/fetal tachy uterine tenderness foul odor of amnionitic fluid ```

Question 32

culture of amniotic fluid

Answer 32

gold standard for intrauterine infection - most specific limited by fact that it takes days to get results so not clinically useful

Question 33

treatment of chorioamnionitis

Answer 33

IV ampicillin q6hrs | gentamicin q8hrs

Question 34

PCN allergic patient with chorioamnionitis

Answer 34

vancomycin IV q12hrs

Question 35

27yo G3P1 F - severe abdominal pain during labor and cessation of contraction - low BP, tachycardia - dry mucous membrane - no fetal heart sounds

Answer 35

uretine rupture

Question 36

uterine rupture

Answer 36

frequent cause of maternal and fetal death in developing countries

Question 37

classification of uterine rupture

Answer 37

spontaneous vs. traumatic complete vs. incomplete anatomical site

Question 38

hx with uterine rupture

Answer 38

previous C section, uterine surgery, cervical cerclage

Question 39

risk fx uterine rupture

Answer 39

``` previous uterus surgery uterotonic drug use prolonged and obstructed albor early pregnancy in young malnutrition ```

Question 40

tx of uterine rupture

Answer 40

initial - resuscitation with crystalloid fluids, blood products gastric decompression urinary cath broad spectrum antibiotics TAH

Question 41

tx order of uterine rupture

Answer 41

``` uterine massage IV access/bladder cath oxygen labs electrolytes oxytocin cytotec hemabate bakri balloon tranexamic acid D and C ```

Question 42

HTN

Answer 42

no methergine

Question 43

asthma

Answer 43

no hemabate