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