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48 Cards in this Set
- Front
- Back
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PPROM
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Preterm Premature Rupture of Membranes
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Preterm PROM
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Rupture of Membranes <37 weeks gestation
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Risk For PPROM
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hx of preterm labor
infection dental gingivitis preeclampsia hydramnios |
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PROM
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premature rupture of membranes
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premature rupture of membranes
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any rupture of membranes that begins one hour before contractions begin
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ROM
complications |
infection
cord compression cord prolapse |
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PPROM
Complications |
infection
cord compression cord prolapse mal presentation induction cord compression |
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AROM
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Artificial Rupture of Membranes
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Artificial Rupture of Membranes
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the rupture of membranes by the midwife using an amni cot or amni hook
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AROM
Indications |
clinical judgement of midwife, including
labor dystocia, persistent "lip" or stalled labor at pushing mother asks for breaking of the water |
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AROM
Contraindications |
maternal refusal
dilation <4 cm station higher-1 Malpresentation GBS + status head not well applied to cx Breech high in the pelvis |
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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 |
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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. |
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Induction of labor
Castor oil |
2T of castor oil in 1/2 cup of juice, and 1 oz of vodka
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Induction of labor
Acupunture |
refer to acupuntcurist
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Preterm Labor
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4 to 6 or more ctx an hour
WITH cervical change from 20 weeks to prior to 37 weeks gestation |
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Preterm Labor
prevention |
diet,
infection risk reduction, UTIs, GBS, and STIs. |
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preterm labor treastment
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nothing has been proven to stop preterm labor if it is inevitable, you may try alcohol,
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Preterm labor
evaluation |
R/O rupture of membranes
cervical evaluation for softening, effacements, and dilation |
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SROM
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Spontaneous Rupture of Membranes
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Spontaneous Rupture of Membranes
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ROM after labor has commenced
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Spontaneous Rupture of Membranes
complicatons |
infections
cord prolapse cord compression |
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Spontaneous Rupture of Membranes
risks |
labor
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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 |
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Signs of infection during Labor
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temp of 100.4 or greater
FHT tachycardia PPROM |
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Infections in labor
treatment |
transport to hospital for treatment
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Infection in labor
prevention |
limit cervical checks especially after ROM, risk reduction for STIs, If GBS positive use hebiclens when conducting a vag exam,
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PPROM/labor commencement
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Labor begins within 24 horus for 85% of women who have PROM.
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GBS
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group B streptococcus
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GBS
screening |
at 36 weeks, a culture of the vagina and anus, 10 to 30 % of women are colonized with GBS
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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 |
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GBS Risk factors
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<20 years of age, african american decent, labor < 37 weeks gestation, ROM>18 hours, fever during labor
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GBS complications
Early onset |
begins between birth and 7 days postpartum. Causes menengitis, sepsis, and pneumonia
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GBS early onset
symptoms |
feeding difficulty
sleepiness irritability lethargy and fever |
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GBS signs and tests
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fever
blood culture CBC |
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risk based management of GBS positive women
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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 |
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GBS PROM management
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Encourage labor to commence ASAP
use non allopathic induction methods Discuss risk and benefits of induction of labor with mother, informed right of refusal |
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Induction of Labor
Stripping membranes |
during vaginal exam locate os of cervix, and carefully sweep membranes using your fingers.
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Induction of Labor
Stripping of Membranes contraindications |
cervix not favorable
baby high mother does not want it |
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Induction of labor
Stripping of membranes complications, unattended consequences |
infections, ROM, less evidence of effectiveness
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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 |
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PROM
Transfer of care |
if S &S of infection occur,
prolonged rupture of membranes >24 hours without labor commencing if mother wants to transport |
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PROM or PPROM, SROM
symptoms |
gush of water, or trickle of water. May occur immediately before ctx start
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ROM
Evaluation |
Color
Odor Amount and Time use of nitrazine paper to confirm water has broken. |
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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
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Post Date Pregnancy
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a pregnancy that has continued past 42 weeks gestation LMP
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Post Date Pregnancy
EDD evaluation |
early in pregnancy review LMP/LMNP
cycle length sexual history past pregnancy history |
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Continuing Pregnancy
Evaluation 41 to 42 weeks |
Auscultated test
Listen to FHTs |
