Today, we have Dr. Karen Shackelford from Bard Vitals, joining us as we break down another question.
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A young woman is 26 weeks pregnant. She's 25 years old. Gravida 1 Para 0. 26 weeks gestation. She came into the emergency department complaining of leaking vaginal fluid for about three days, not huge, just some leaking.
She's had some intermittent contractions but they're fairly infrequent. A sterile speculum exam is performed. It revealed some pale, yellow, watery fluid in the vaginal valve. Her cervix is dilated 4 cm. The vaginal fluid is tested, has a pH of 7.1.
This is at an academic center where they still do the Fern test with arborization when the fluid is examined under a slide. An ultrasound is performed and it reveals oligohydramnios.
Which of the following measures is appropriate in the management of this patient? Her lab results and her pee is negative for Group B Strep.
(A) Ovarian section
(B) Flush immediate delivery
(C) Antibacterial prophylaxis for Group B Strep
(D) Tocolysis
(E) Supplemental progesterone
There is a premature rupture of membranes (PROM). If it were a placental abruption, we can take it to a C-section. But for PPROM (preterm PROM) before 37 weeks, you want to delay the delivery as long as you can. So the correct answer here is the antenatal steroid therapy to mature the lungs.
Most women who have PPROM deliver within a week. If it is within 7 days, you should initiate the steroid therapy.
The management of PPROM would depend on factors like the gestational age, the presence or absence of infection, presence or absence of labor, any sign of abruption. Fetal stability and heart monitoring should also be managed.
The American College of Obstetricians and Gynecologists (ACOG) recommends that women who have PPROM who are more than 34 weeks of gestation should deliver. But it doesn't need to be a C-section. Normal spontaneous or induced vaginal delivery is fine.
In women less than 34 weeks, the pregnancy should be managed expectantly just until fetal maturity development. As long as the fetus is stable, the fetus will benefit by prolonging time in the uterus.
Having the antenatal steroids will improve lung maturation. But you have to balance that with the benefits like expectant management against the risks associated with like a prolonged PPROM. Placental abruption is an increased risk as well as cord prolapse or cord compression.
In the lab results, the patient had a negative Group B Strep test. Antibacterial prophylaxis for Group B Strep is indicated if somebody delivers within 48 hours in an unknown status or a positive test.
But you give these patients antibiotics as it prolongs the latency of the pregnancy. It's generally associated with better fetal results. It reduces respiratory distress syndrome and neonatal death. It reduces the risk of intraventricular hemorrhage, necrotizing enterocolitis, and all preemie problems.
It also reduces the duration of neonatal respiratory support needed. There's no increase in maternal or neonatal infection to balance that. ACOG recommends the...