OBS Complications YOSOR PDF
OBS Complications YOSOR PDF
OBS Complications YOSOR PDF
Management:
• Decisions based on EGA, estimated weight of fetus, existence of contraindications
to suppressing preterm labor (table next slide)
Risk factors:
1. Decidual hemorrhage
2. History of preterm birth
3. Bacterial colonization
4. Invasive procedures (amniocentesis)
Clinical features:
➢ Sudden gush of fluid or continued leakage.
➢ Color and consistency of fluid and presence of flecks of vernix or meconium
➢ Reduced size of the uterus, and increased prominence of the fetus to palpation
Sterile Speculum Examination:
1. Pooling—collection of amniotic fluid in the posterior fornix
2. Nitrazine test: sterile cotton-tipped swab should be used to collect fluid from the posterior fornix and
apply it to Nitrazine (phenaphthazine) paper. In the presence of amniotic fluid, the Nitrazine paper
turns blue, demonstrating an alkaline pH (7.0–7.25)
3. Ferning: fluid from the posterior fornix is placed on a slide and allowed to air-dry. Amniotic fluid will
form a fernlike pattern of crystallization.
CHORIOAMNIONITIS: most common organisms are those ascend from the vagina (E-coli, Bacteroides,
GBS). The most reliable signs of infection include the following:
➢ (1) Fever: temperature should be checked every 4 hours.
➢ (2) Maternal leukocytosis: daily leukocyte count and differential can be obtained.
➢ (3) Uterine tenderness: check every 4 hours.
➢ (4) Tachycardia—maternal pulse >100 beats/min or fetal HR >160 beats/min—is suspicious.
➢ (5) Foul-smelling amniotic fluid.
Treatment:
• Depends on gestational age, -+ chorioamnionitis
➢ A. Chorioamnionitis: DELIVERY regardless gestational age +ABX → if pt not in labor > Induction
➢ B. W/O chorioamnionitis: divided into>> 1* term, late preterm 2* early preterm
1. Term/Late preterm: active mt with induction of labor at time of presentation for woman with PROM at term
(>37) is preferred. Late preterm (34-36 6/7).
2. Early preterm: (btw 24-33 6/7) → ABX (ampicillin + erythromycin), corticosteroids (lung maturity), Mg+
(neuroprotection, btw 24-32 weeks not beyond).
• Timing of delivery preterm: optimal is 34 0/7 weeks.
• BUT immediate regardless age if: →Non-reassuring fetal status, labor, chorioamnionitis, or mature lung indices on
AF evaluation.
• Tocolytic: in PPROM, should be avoided entirely, or limited to 48 hrs duration.
January 2021
Which of the following is included in the management of premature
rupture of membranes on the 33rd week of gestation during the first
48 hours given chorioamnionitis was ruled out?
A) Ampicillin & Erythromycin & steroids (correct)
B) Ampicillin & steroids & tocolytics
C) Ampicillin & steroids & magnesium for fetal neuroprotection
D) Ampicillin & erythromycin & steroids & tocolytics & magnesium for
fetal neuroprotection
E) Ampicillin & steroids & induction of labor
Breech presentation
➢ 3–4% of all pregnancies
➢ 3 types according to attitude→ 1) frank (hip flexed, extended knees), 2) complete (hip
and knees flexed), 3) footling ( 1 single footling breech, double footling, legs extended
below level of buttocks)
➢ Fetal position→ determined by fetal sacrum as point of reference to maternal pelvis. 8
options (SA, SP, LST, RST, LSA, LSP, RSA, RSP)
➢ Station→ location of sacrum with regard to maternal ischial spine
• Before 28 weeks, fetus is small enough in relation to intrauterine volume to rotate from cephalic to
breech presentation and back again with relative ease.
• Causes:
1. Oligohydramnios, polyhydramnios
2. Uterine anomalies (bicornuate or septate uterus)
3. Pelvic tumors obstructing the birth canal
4. Abnormal placentation (placenta previa)
5. Advanced multiparity
6. Contracted maternal pelvis
7. Multiple gestation (25% incidence of breech in first twin, 50% for second twin)
• Antepartum Management:
➢ Version is procedure used to turn the fetal presenting part from breech to cephalic presentation
(cephalic version) or from cephalic to breech presentation (podalic version)
➢ External cephalic version (ECV)→ cephalic version is performed by manipulating the fetus through
the abdominal wall (used frequently), used in singleton breech presentations or in a nonvertex
second twin
➢ Internal podalic version (IPV)→ performed by means of internal maneuvers (rarely used),
primarily for delivering second twin
• External Cephalic Version (ECV):
➢ Used in mt of singleton breech presentations or in a nonvertex second twin
➢ Performed in patients at or beyond 37 0/7 weeks
➢ Unengaged singleton breech presentations of at least 37 weeks’ gestation are candidates for
ECV
➢ Successful in→ multigravidas, those with a transverse or oblique lie, those with a posterior
placenta
➢ Use of terbutaline tocolytic increases success rate