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48 Cards in this Set

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PPROM
Preterm Premature Rupture of Membranes
Preterm PROM
Rupture of Membranes <37 weeks gestation
Risk For PPROM
hx of preterm labor
infection
dental gingivitis
preeclampsia
hydramnios
PROM
premature rupture of membranes
premature rupture of membranes
any rupture of membranes that begins one hour before contractions begin
ROM
complications
infection
cord compression
cord prolapse
PPROM
Complications
infection
cord compression
cord prolapse
mal presentation
induction
cord compression
AROM
Artificial Rupture of Membranes
Artificial Rupture of Membranes
the rupture of membranes by the midwife using an amni cot or amni hook
AROM
Indications
clinical judgement of midwife, including
labor dystocia, persistent "lip" or stalled labor at pushing
mother asks for breaking of the water
AROM
Contraindications
maternal refusal
dilation <4 cm
station higher-1
Malpresentation
GBS + status
head not well applied to cx
Breech high in the pelvis
Induction of labor with PROM
Complementary medicine
Acupuncture
Herbs, blue and black cohosh, herblore tincture, homeopathic, caulophylum cimicifuga, pulsatilla for posterior, and whimpering mom.
nipple stim
Induction of labor
Nipple stimulation
monitor FHTs, establish baseline and absence of decels,
demonstrate rolling of nipple to couple
roll for 5 minutes on one breast then change to other nipple.
Monitor FHTs during and after ctx.
Stop nipple stim if decels occur or if ctx are q 3 min or closer.
Induction of labor
Castor oil
2T of castor oil in 1/2 cup of juice, and 1 oz of vodka
Induction of labor
Acupunture
refer to acupuntcurist
Preterm Labor
4 to 6 or more ctx an hour
WITH cervical change from 20 weeks to prior to 37 weeks gestation
Preterm Labor
prevention
diet,
infection risk reduction, UTIs, GBS, and STIs.
preterm labor treastment
nothing has been proven to stop preterm labor if it is inevitable, you may try alcohol,
Preterm labor

evaluation
R/O rupture of membranes
cervical evaluation for softening, effacements, and dilation
SROM
Spontaneous Rupture of Membranes
Spontaneous Rupture of Membranes
ROM after labor has commenced
Spontaneous Rupture of Membranes
complicatons
infections
cord prolapse
cord compression
Spontaneous Rupture of Membranes
risks
labor
ROM
clinical guidelines for F/U for all ROM
Monitor FHTs for decels
Evaluate for cord prolapse or occult cord prolapse
vitals q 2 hours including temp
Increase fluid intake
Signs of infection during Labor
temp of 100.4 or greater
FHT tachycardia
PPROM
Infections in labor
treatment
transport to hospital for treatment
Infection in labor
prevention
limit cervical checks especially after ROM, risk reduction for STIs, If GBS positive use hebiclens when conducting a vag exam,
PPROM/labor commencement
Labor begins within 24 horus for 85% of women who have PROM.
GBS
group B streptococcus
GBS
screening
at 36 weeks, a culture of the vagina and anus, 10 to 30 % of women are colonized with GBS
GBS
prophalaxisis
Recommended Penicillin G, 5 million units IV
initial dose, then 2.5 million
units IV every 4 hours until
delivery
Alternative Ampicillin, 2 g IV initial dose,
then 1 g IV every 4 hours until
delivery
If penicillin allergic†
Patients not at high Cefazolin, 2 g IV initial dose,
risk for anaphylaxis then 1 g IV every 8 hours until
delivery
CDC GBS guidlines
GBS Risk factors
<20 years of age, african american decent, labor < 37 weeks gestation, ROM>18 hours, fever during labor
GBS complications
Early onset
begins between birth and 7 days postpartum. Causes menengitis, sepsis, and pneumonia
GBS early onset
symptoms
feeding difficulty
sleepiness
irritability
lethargy and fever
GBS signs and tests
fever
blood culture
CBC
risk based management of GBS positive women
transfer for prophylaxis if labor or ROM begins <37 weeks gestation
tempature of 100.4 tempature

Provide prophylaxis for GBS + women with ROM > 18 hours
GBS PROM management
Encourage labor to commence ASAP
use non allopathic induction methods
Discuss risk and benefits of induction of labor with mother, informed right of refusal
Induction of Labor
Stripping membranes
during vaginal exam locate os of cervix, and carefully sweep membranes using your fingers.
Induction of Labor
Stripping of Membranes
contraindications
cervix not favorable
baby high
mother does not want it
Induction of labor
Stripping of membranes
complications, unattended consequences
infections, ROM, less evidence of effectiveness
Labor induction
Contraindications for complimentary medicine
maternal infection
maternal refusal
high baby in breech position
preterm or at term without definite dates
high risk pregnancy
clinical judgement of midwife
PROM
Transfer of care
if S &S of infection occur,
prolonged rupture of membranes >24 hours without labor commencing
if mother wants to transport
PROM or PPROM, SROM
symptoms
gush of water, or trickle of water. May occur immediately before ctx start
ROM
Evaluation
Color
Odor
Amount and
Time
use of nitrazine paper to confirm water has broken.
ROM
Meconium Staining
Evaluate Mec, tea stained, light, moderate, or thick. Evaluate FHTs and maternal infection, Transport for care if decels are heard or there are signs of infection
Post Date Pregnancy
a pregnancy that has continued past 42 weeks gestation LMP
Post Date Pregnancy
EDD evaluation
early in pregnancy review LMP/LMNP
cycle length
sexual history
past pregnancy history
Continuing Pregnancy
Evaluation
41 to 42 weeks
Auscultated test
Listen to FHTs