PROM and chorioamnionitis and postpartum hemorrhage Flashcards Preview

Year2 Repro exam II > PROM and chorioamnionitis and postpartum hemorrhage > Flashcards

Flashcards in PROM and chorioamnionitis and postpartum hemorrhage Deck (57):
1

risks for preterm premature rupture of uterine membranes

previous PROM, preterm labor, vaginal uteral infections, smoking, mechanical stress, GU tract infections, antepartum bleeding

2

tests to see if membranes have ruptured

nitrazine and fern test(amnionitc fluid detection)

3

need to rule out what for pprom

urinary incontinence, vaginal discharge, perspiration

4

when is PPROM

PROM before 37 weeks gestation

5

what is mid trimester PROM

PROM 14-26 weeks gestation

6

women with PPROM have increased risk of what

placental abruption
umbilical cord prolapse
pulmonary hypoplasia

7

Tx PPROM

delivery asap

8

when do we give antibiotics for those with PPROM

24-32 weeks
>32 weeks but <34 weeks

9

what antibiotic is used in PPROM? for what pathogen?

ampicillin IV
group B strep

10

what steroid is given to mom if PPROM

bethamethasone for lung maturity

11

what are tocolytics

delay delivery for 48 hours
Mg sulfate

12

side effects Mg sulfate

HA flushing, fatigue, diplopia, DTRs
respiratory depression and cardiac arrest at toxic levels

13

what antibiotic is given for chlamydia tachomatis

azithromycin

14

if penicillin allergy in mom with PPROM what is given

clinda or genta. or cefazolin and cephalexin

15

mother with difficult labor
temperature rises and foul odor present
tachycardia
Dx? and Tx?

chorioamnionitis
gentamycin, clinda or vanco

16

what is chorioamnionitis

infection of amniotic fluid, membranes, placenta or decidua

17

chorioamnionitis is associated with what complications

early neonatal sepsis and penumonia

18

what is a common cause of transplacental infection

listeria monocytogenes

19

what procedures could increase risk of chorioamnionitis

amniocentesis, chorionic villus sampling, fetal surgery

20

risk factors for chorioamnionitis

prolonged labor, prolonged membrane rupture
multiple digital vaginal examinations
nulliparity
previous IAI
meconium stained amniotic fluid,
internal fetal or uterine monitoring
presence of genital tract pathogens
alcohol
tobacco
PROM

21

clinical presentation of chorioamnionitis

fever
uterine tenderness
maternal tachy
fetal tachy
purulent or foul amniotic fluid
maternal leukocytosis

22

risks with labor if have chorioamnionitis

uterine atony
postpartum hemorrhage
endometritis

23

how can chorioamnionitis affect contractions

dysfunctional myometrial contractility from inflammation

24

risks if C section with chorioamnionitis

wound infection, endomyometritis
venous thrombosis

25

what is ddx for chorioamnionitis

pyelonephritis, influenza, appendicitis, pneumonia

26

most specific documentation for intraamnionic infection

culture of amniotic fluid

27

standard Tx for chorioamnionitis

ampicillin 2 g IV q 6 hours
gentamycin 1.5mg/kg q8hr

28

what to use for Tx in chorioamnionitis when patient has penicillin allergy

vanco

29

causes of uterine rupture related to pregnancy

chorioamnionitis
abruptio placentae
rupture of gravid uterus

30

causes of uterine rupture uncrelated to pregnancy

torsion ovarian cyst or rupture
strangulated hernia, intestinal obstruction
renal colic, acute appendicitis

31

anatomical sites of uterine rupture

anterior left transverse, lateral, fundal, combination

32

associations of prio births with uterine rupture

previous c section
previous uterine surgery
cervical cerclage in place

33

risk factors uterine rupture

previous uterine surgery
use of uterotonic drugs
instrument assisted delivery
prolonged and obstructed labor
early pregnancy in young immature girls
malnutrition
tradition (female circumcision)

34

initial care of uterine rupture

resuscitation with crystalloid fluids, blood products
gastric decompression
urinary catheterization
broad spectrum antibiotics

35

what laparotomy techniques are used for uterine rupture

repaire w/ or w/o tubal ligation
TAH

36

post op for uterine rupture

transfusion, bladder rest, wound care, antibiotics
counseling
monitor for obstetrical fistula

37

significant bleeding in 31 wk pregnant woman
some contractions, no abdominal pain, no recent trauma, mass in abdomen mobile nontender
ddx?

placenta previa
placenta abruption
displacement cervical mucus plug
PROM
cervicitis
vaginitis/vulvovaginitis

38

painless bleeding in third trimester, imaging?

transvaginal US

39

hemabate is used for what

stop bleeding

40

what is placenta previa

placental tissue over or adjacent to os

41

what is marginal placenta previa

edge of placenta is at margin of internal os

42

what is low lying placenta

placenta is implanted in lower uterin segment and does not reach os but is close

43

what is vasa previa

fetal vessels present at cervical os

44

risk factors placenta previa

previous one
previous c section
multiple gestation
multiparity
advanced maternal age
infertility Tx
previous abortion
previous intrauterine surgical procedure
maternal smoking
maternal cocaine use
male fetus
non-white race

45

tx asymptomatic previa

monitor with US as outpatient, avoid strenuous exercise, planned CS for delivery

46

Tx bleeding previa

potential EM
hospitalize for monitoring, CS if hemorrhage

47

when is vaginal delivery attempted in placenta previa

if placental edge is > 10 mm from internal os due to lower risk of hemorrhage during labor

48

what is too much blood loss in vaginal delivery? CS?

>500mL vaginal
>1000 mL CS

49

what are the 4 Ts of postpartum hemorrhage

tone
trauma
tissue
thrombus

50

what is tone in postpartum hemorrhage

no contraciton, sprial arterioles and decidual vv continue to bleed

51

Tx of atony in postpartum hemorrhage

massage
pitocin and cytotec
methergine or hemabate

52

methergine should not be used to stop bleeding in what patients

HTN

53

hemabate should not be used to stop bleeding in what patients

asthma

54

causes of PPH from trauma

lacerations (forceps or extractors)
uterine inversion (improper management in 3rd stage of labor)

55

Tx if uterus is unable to contract and involute around retained placental tissue mass

manual removal
dilation and curettage

56

what type of thombi can cause postpartum hemorrhage

ITP platelets)
amnionic fluid embolus
vwDisease

57

Tx for thrombi causing post partum hemorrhage

coagulation studies