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REPRO II Exam 2 > Dunn OB/GYN III > Flashcards

Dunn OB/GYN III Flashcards

1
Q

PPROM

A

preterm premature rupture of membranes

if before 37 weeks

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2
Q

risk of PPROM

A

pervious PROM
preterm labor
vaginal uteral infection
smoking

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3
Q

digital exam

A

with ruptured membrane

-don’t want to introduce bacteria

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4
Q

nitrazine

A

examine pH

blood and semen - false positive

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5
Q

ferning

A

amniotic fluid

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6
Q

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

A

PPROM - diagnosis

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7
Q

PROM

A

premature rupture of membranes

spontaneous rupture - prior to onset of labor

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8
Q

midterm PROM

A

14-26 weeks

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9
Q

risk factors for PPROM

A 
infection - GI**
previous PPROM
antepartum bleeding
smoking - 2-4x increased
mechanical stress - twins, trauma, polyhydramnios
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10
Q

management of PPROM

A

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

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11
Q

1/3 women with PPROM

A

potential serious intrauterine infections

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

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12
Q

PPROM 24-32 weeks

A

antibiotics and group B strep at delivery if indicated

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13
Q

32-34 weeks PPROM

A

antibiotics and group B strep prophylaxis at delivery if indicated

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14
Q

> 34 weeks PPROM

A

group B strep prophylaxis beyun on admission and continued until delivery

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15
Q

antibiotics for PPROM

A

ampicillin 2g IV once, followed by 1g q6hrs

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16
Q

steroids and PPROM

A

only if patient <34 weeks

for fetal lung maturity

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17
Q

betamethasone

A

corticosteroid

for fetal lung maturity

12mg IM daily - 2 doses

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18
Q

tocolytics

A

stop labor
-delay delivery for 48 hours

Mg sulfate

19
Q

magnesium sulfate

A

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

watch for headache, flushing, fatigue, diplopia

toxic levels - resp and cardiac arrest

20
Q

group B strep

A

ampicillin

21
Q

azithromycin

A

genital mycoplasmas

protect chorioamnionitis and provide chlamydia coverage

22
Q

PCN allergy

A

cefalozin and cephalexin

or clindamycin and gentamycin

23
Q

intraamniotic infection

A

chorioamnionitis

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

20-40% early neonatal sepsis and pneumonia

cervicovaginal flora migration

membrane rupture - facilitates process

24
Q

transplacental infection

A

uncommon chorioamnionitis

-listeria monocytogenes

25
Q

other uncommon methods of chorioamnionitis infection

A

amniocnentesis
chorionic villus sampling
fetal surgery

26
Q

chorioamnionitis organisms

A 
ureaplasma urealyticum
gram negative anaerobes
mycoplasma hominis
bacteroids bivius
gardnerella vaginalis
group B strep - 15%
27
Q

risk fx for chorioamnionitis

A 
long labor
long membrane rupture
digital vaginal exams
nulliparity
previous
meconium in amniotic fluid
internal fetal monitoring
alcohol
tobacco
genital tract pathogens
PROM
28
Q

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

A

chorioamnionitis

29
Q

fetal tachy

A

> 160

30
Q

risks with chorioamnionitis

A

labor abnormalities
dysfunctional uterine myometrium - inflammation

C section - wound infection, endomyometritis, venous thrombosis

31
Q

diagnosis of chorioamnionitis

A 
fever
maternal leukocytosis
maternal/fetal tachy
uterine tenderness
foul odor of amnionitic fluid
32
Q

culture of amniotic fluid

A

gold standard for intrauterine infection - most specific

limited by fact that it takes days to get results

so not clinically useful

33
Q

treatment of chorioamnionitis

A

IV ampicillin q6hrs

gentamicin q8hrs

34
Q

PCN allergic patient with chorioamnionitis

A

vancomycin IV q12hrs

35
Q

27yo G3P1 F

  • severe abdominal pain during labor and cessation of contraction
  • low BP, tachycardia
  • dry mucous membrane
  • no fetal heart sounds
A

uretine rupture

36
Q

uterine rupture

A

frequent cause of maternal and fetal death in developing countries

37
Q

classification of uterine rupture

A

spontaneous vs. traumatic
complete vs. incomplete

anatomical site

38
Q

hx with uterine rupture

A

previous C section, uterine surgery, cervical cerclage

39
Q

risk fx uterine rupture

A 
previous uterus surgery
uterotonic drug use
prolonged and obstructed albor
early pregnancy in young
malnutrition
40
Q

tx of uterine rupture

A

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

TAH

41
Q

tx order of uterine rupture

A 
uterine massage
IV access/bladder cath
oxygen
labs
electrolytes
oxytocin
cytotec
hemabate
bakri balloon
tranexamic acid
D and C
42
Q

HTN

A

no methergine

43
Q

asthma

A

no hemabate

REPRO II Exam 2 (21 decks)

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