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22 Cards in this Set
- Front
- Back
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Premature rupture of membranes (PROM) and Preterm premature rupture of membranes (PPRMO): - Define? |
PROM- amniorrhexis (spontaneous rupture of membranes as opposed to amniotomy) before the onset of labor at any stage of gestation
PPROM- preterm w/ ruptured membranes, whether or not they have contractions. |
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What are some of the causes of PROM? |
- Vaginal and cervical infections - Abnormal membrane physiology - Incompetent cervix - Nutritional deficiencies |
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Diagnosis of PROM: - Made how? - Rule out what? |
- Based on history of vaginal loss of fluid and confirmation of amniotic fluid in the vagina.
- Episodic urinary incontinence, leukorrhea, or loss of the mucous plug must be ruled out.
- ***Because of the risk of introducing infection and the usually long latency period f/ the time of exam until delivery, the examiner's hands should not be inserted into eh vagina of a patient who is not in labor, whether preterm or term.*** |
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PROM: - What is seen on exam? - Confirmation of PROM can be made how? |
- Pooling of amniotic fluid in the posterior vaginal fornix. A valsalva maneuver or slight fundal pressure may expel fluid from the cervical os.
- Confirmation of the diagnosis can be made by: 1. Testing the fluid with Nitrazine paper, which will turn blue in the presence of the alkaline amniotic fluid and 2. Placing a sample on a microscopic slide, air drying, and examining for ferrying. |
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PROM Diagnosis: - What makes false positive results with Nitrazine test? - In presence of blood, how might it appear? |
- False-positive Nitrazione test results occur in the presence of alkaline urine, blood, or cervical mucus.
- In the presence of blood, which is usually seen in patents who are also in early labor, the pattern may appear to be skeletonize, and a distinct ferrying may not be seen. |
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Amniotic fluid index (AMI) |
Measurement of vertical axis of amniotic fluid present in four quadrants, the total is the AFI. A value of < 5 cm is considered abnormal. |
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What might lead to pulmonary hypoplasia? |
Oligohydramnios associated with PROM in the fetus at < 24 weeks gestation |
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What to do if PROM occurs at 36 weeks or later and the cervix is favorable? Unfavorable? |
Labor should be induced after 6 to 12 hours if no spontaneous contractions occur.
In presence of unfavorable cervical condition w/ no evidence of infection, it is reasonable to wait 24 hours before induction of labor to decrease the risk of failed induction and maternal febrile morbidity.
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How might chorioamnionitis present? |
PROM and a high maternal temperature (> 100.4), fetal tachycardia, and a tender, sometimes irritable, uterus. |
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What antibiotics should you give to PPROM? |
Ampicillin or erythromycin |
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What to give patients once chorioamnionitis is diagnosed? |
- Ampicillin and gentamycin in combination. If PNC sensitive, give cephalosporins. Once AB have been started, labor should be induced.
- If the condition of the cervix is unfavorable and there is evidence of fetal involvement, it may be necessary to perform a cesarean delivery. |
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Use of tocolytics therapy in PROM? |
- Controversial. My mask evidence of maternal infection. But, may delay labor and thus allow time for pulmonary maturation.
- In the presence of infection, tocolysis is usually unsuccessful****** |
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Outpatient management of PROM? |
- Afte inpatient observation for 2-3 days, without infection, you can do outpatient IF the patient is reliable, the fetus is in vertex position, cervix is closed.
- At home, restrict physical activity, no coital activity should occur, and patient must monitor her temperature at least 4 times per day. Return if temp > 100.4
- See patient weekly, at which time you should take her temp, perform a nonusers test after 28 weeks, and baseline fetal heart rate and AFI. Do U/S every 2 weeks.
- Any patient with oligohydramnios is NOT a candidate for outpatient management. |
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Surfactant: - produced how? |
Synthesis takes place in the type II pneumocytes by incorporation of choline, a signifiant recycling seems to occur by resorption and secretion. |
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Important phospholipids for lung maturity? |
Phosphatidylcholine (lecithin) and phosphatidylinositol (PI) and phosphatidylglycerol (PG) |
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How do you measure lung maturity? |
- Using a two-dimensional thin-layer chromatography, both PG and PI can be measured. Along w/ the L/S ratio, these make up the lung profile.
- If L/S > 2 and PG is present, RDS is rare.
- When L/S ratio < 2 but PG is present, fewer than 5% of infants develop RDS. |
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What is a rapid way to measure lung maturity? |
Lamellar body number density (LBND) assessment, performed using an electronic cell counter (Coulter), which is gaining increased interest and use.
- Can be completed within 2 hours.
- Normal is > or equal to 46,000 uL LBND |
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Intrauterine growth restriction (IUGR): - Definition? |
When the birth weight of a newborn infant is below the 10th percentile for a given gestational age. |
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Growth-restricted fetuses: - Prone to what problems? |
- Meconium aspiration - Asphyxia - Polycythemia - Hypoglycemia - Mental retardation - Adult onset illnesses such as HTN, DM, and atherosclerosis |
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What are the causes of IUGR? |
1. Maternal - Poor nutritional intake - Cigarette smoking - Drug use - ETOH - Cyanotic heart disease - Pulmonary insufficiency - Antiphospholipid syndrome - Hereditary thrombophilias
2. Placental - Essential HTN - Chronic renal disease - Pregnancy-induced HTN
3. Fetal - Inadequate or altered substrate is present - Intrauterine infection - Congenital anomalies |
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Types of fetal growth restriction? |
1. Symmetrical - growth of both the head and body is inadequate
2. Asymmetrical - the brain is preferentially spared at the expense of abdominal viscera. As a result, the head size is proportionally larger than the abdominal size. The liver and pancreas undergo the most dramatic anatomic and biochemical changes. |
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What should serve as the primary screening tool for IUGR?
What is the most effective parameter for producing fetal weight? |
Serial uterine fundal height measurements
Abdominal circumference |
