PROM, Induction, & Augmentation Of Labor Flashcards
What are the significance of rupture of membranes?
Umbilical cord prolapse = can occur if the presenting part is not fixed in the pelvis
Beginning of labor
Intrauterine & neonatal infection = if deliveryis delayed
What is the diff betw PROM & PPROM?
PROM (Prelabor Rupture of Membranes)
- rupture of membrane occurs from 37 weeks of gestation onwards
PPROM (Preterm Prelabor Rupture of Membranes)
- rupture of membrane occurs <37 wks of gestation
How do u categorize if rupture of membrane is prolonged?
If it persists >24 hrs & prior to onset of labor
What is the most common identifiable risk factor for PROM?
Genital tract infection
What enzymes can weaken the amnion and chorion brough by microorganisms that ascend the vagina?
Collagenases
Mucinases
Proteases
What are the predisposing factors of PROM?
Intrauterine infection
Oxidative stress-induced DNA damage
Premature cellular senscence
What are the risk factors for PROM?
Low socio-economic status
BMI <19.8
Nutritional deficiencies
Cigarette smoking
1 risk of recurrence in subsequent pregnancy
How do you diagnose PROM?
Water vaginal discharge
confirmed on sterile speculum exam
During sterile speculum examination, what should u take note upon looking at the cervix to diagnose PROM?
Visual pooling of fluid in the poterior vaginal fornix or leakage of fluid in the posterior vaginal fornix or leakage of fluid from the cervical os
How do u differentiate amniotic fluid from urine?
Urine = can be controlled ang leakage
Amniotic fluid = continuous or intermittent and uncontrollable
What is a confirmatory test for ruptured membranes?
Ferning test
(+) ferning = positive result
What are other proteins used to detect PROM?
AFP
Placental alpha microglobulin 1
Insulin factor growth binding protein-1
What is the meaning of augmentation of labor?
Enhancement of spontaneous contractions considered inadequate beause of failed cervical dilation & poir fetal descent
What is the importance of induction of labor?
Benefits to either mother or fetus outweighs thoes of pregnancy continuation (>96 hrs ff membrane rupture)
Lower risk of chorioamnionitis, endomitriosis, NICU admission
Fewer intrapartum & postpartum infection
What are indications of induction of labor?
Membrnae rupture without labor
Gestational hypertension
Oligohydramnios
Non-reassuring fetal status
Post-term pregnancy
Maternal medical conditions: Chronic HTN, DM
What are maternal CIs to induction & augmentation?
Abnormally impalnted placentas (vasa previa, placenta previa)
Prior uterine incision
COntracted or distorted pelvic anatomy
Active genital herpes infection
Cervical cancer
What are fetal CIs of induction & augmentation?
Appreciable macrosomia
Severe hydrocephalus
Malpresentation
Non-reassuring fetal status
What are the risks of underoing induction or augmentation of labor?
Chorioamnionitis
Uterine rupture
Postpartum hemorrhage from uterine atony
Comparable or lower CS rates in induction of labor vs spontaneous labor
What are the pre-induction assessment questions?
- Is there a compelling indication for induction?
- Is the AOG accurate?
- Is the fetal presentation, size and well being appropriate for induction
- Is the maternal pelvis adequate for vaginal delivery?
- What is the likelihood that the cervix will respond to induction?
What is elective labor induciton?
Initiation of labor for convenience in a person with a term pregnancy who doesnt medically need the intervention
What is the AOG for elective inuction?
Not <39 wks of pregnancy
What are logistic reasons for elective labor induction?
A risk for rapid labor
Woman who lives a long distanec from the hospital
Psychosocial indications
What are factors affecting success of induction/?
Younger age
Multiparity
BMI <30
Favorable cervix
Birthweght <3500g
What are the 5 parameters of the Bishop score?
Dilation = most imoprtant predictor
Effacement
Station of the fetal head
Consistency
Position
