OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
G1P0 woman at 36 weeks presents w/ *persistent wetness* of her
underwear and now has *fever* and *uterine tenderness*. Lab
values show *Leukocytosis*.
Fluid pooled in posterior vaginal fornix is nitrazine positive and has
ferning pattern on cover slip
Other possible sx = *maternal or fetal tachycardia*, purulent
vaginal discharge, malodorous amniotic fluid.
DX and TX? -
correct answer ✅CHORIOAMNIONITIS
*Premature prolonged rupture of membranes* = PROM -
Premature = rupture <37 weeks; Prolonged = rupture lasting >18
hours w/o delivery; Usually PPROM refers to preterm premature
rupture of the membranes
- All descriptions of fluid point to amniotic fluid.
Increased risk of *Chorioamnionitis and Abruptio placenta*.
,OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
DX here = Chorioamnionitis
TX here =
1. Broad spectrum antibiotics covering anaerobes and
genital/enteric flora = Ampicillin/.Gentamicin and Clindamycin
2. Administer Oxytocin to induce labor. Since there are signs of
infection, DELIVER regardless of gestational age (give
corticosteriods for fetal lungs + antibiotics)
Remember tocolysis contraindicated in the setting of
Chorioamniotitis. For PPROM, start Ampicilllin and Erythromycin
(not as chorio prophylaxis), but as a pseudotocolytic which prolongs
pregnancy by 5-7 days and allows time to get betamethasone
injections
Other things that increase the risk of chorioamnionitis? -
correct answer ✅Prolonged rupture of membranes
Frequent cervical checks
Intrauterine monitoring devices (IUPC, etc)
Prolonged labor
,OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
Presence of genital tract pathogens
Patient who are likely to deliver preterm infant <34 weeks should
get what? -
correct answer ✅Corticosteroids IM (betamethasone) - 2 doses 24
hours apart to help fetal lung maturity
What two things are done in pretty much all patients w/ PROM?
Patient w/ PROM at <34 weeks -
correct answer ✅*34-37 weeks*
1. Antibiotics (Amp+Erythro for prolongation of pregnancy by 5-7
days)
2. +Corticosteroids (technically <34 weeks, but usually this is done
up until 37 weeks for vaginal due to potential dating issues; also
given <39 weeks for scheduled CS)
3. *delivery* - deliver even prior to 34 weeks if signs of
chorioamnionitis are present. If Chorio develops, delivery is
indicated regardless of gestational age.
*<34 weeks* - goal is prolongation of pregnancy if no signs of
infection
, OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
- antibiotics (Ampicillin + Erythromycin)
- IM Betamethasone
- *Mag* is usually started <32 weeks for neuroprotection regardless
of presence of preeclampsia (in delivery likely in next 24 hours)
- indocin also started prior to 32 weeks (AE = oligo, PDA closure,
IVH, necrotizing entercolitis)
- Fetal monitoring
- *if signs of fetal infection or compromise* ( --> Abx,
corticosteroids, magnesium if <34 weeks, DELIVERY)
If patient has PROM at 35 weeks and GBS is unknown - do what? -
correct answer ✅Intrapartum IV penicillin should be given -
assume she has it. Normal vaginal flora in ~25% of women.
This really applies to any precipitous labor in which the GBS status
is unknown. Also do it if they have had GBS bactiuria/UTI at any
point in the pregnancy AND/OR have had a previous delivery
complicated by neonatal GBS septicemia/pneumonia/meningitis.
Goal is to get intrapartum IV penicillin on board for 4 hours before
baby's arrival.
Questions & Answers (Grade A+)
G1P0 woman at 36 weeks presents w/ *persistent wetness* of her
underwear and now has *fever* and *uterine tenderness*. Lab
values show *Leukocytosis*.
Fluid pooled in posterior vaginal fornix is nitrazine positive and has
ferning pattern on cover slip
Other possible sx = *maternal or fetal tachycardia*, purulent
vaginal discharge, malodorous amniotic fluid.
DX and TX? -
correct answer ✅CHORIOAMNIONITIS
*Premature prolonged rupture of membranes* = PROM -
Premature = rupture <37 weeks; Prolonged = rupture lasting >18
hours w/o delivery; Usually PPROM refers to preterm premature
rupture of the membranes
- All descriptions of fluid point to amniotic fluid.
Increased risk of *Chorioamnionitis and Abruptio placenta*.
,OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
DX here = Chorioamnionitis
TX here =
1. Broad spectrum antibiotics covering anaerobes and
genital/enteric flora = Ampicillin/.Gentamicin and Clindamycin
2. Administer Oxytocin to induce labor. Since there are signs of
infection, DELIVER regardless of gestational age (give
corticosteriods for fetal lungs + antibiotics)
Remember tocolysis contraindicated in the setting of
Chorioamniotitis. For PPROM, start Ampicilllin and Erythromycin
(not as chorio prophylaxis), but as a pseudotocolytic which prolongs
pregnancy by 5-7 days and allows time to get betamethasone
injections
Other things that increase the risk of chorioamnionitis? -
correct answer ✅Prolonged rupture of membranes
Frequent cervical checks
Intrauterine monitoring devices (IUPC, etc)
Prolonged labor
,OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
Presence of genital tract pathogens
Patient who are likely to deliver preterm infant <34 weeks should
get what? -
correct answer ✅Corticosteroids IM (betamethasone) - 2 doses 24
hours apart to help fetal lung maturity
What two things are done in pretty much all patients w/ PROM?
Patient w/ PROM at <34 weeks -
correct answer ✅*34-37 weeks*
1. Antibiotics (Amp+Erythro for prolongation of pregnancy by 5-7
days)
2. +Corticosteroids (technically <34 weeks, but usually this is done
up until 37 weeks for vaginal due to potential dating issues; also
given <39 weeks for scheduled CS)
3. *delivery* - deliver even prior to 34 weeks if signs of
chorioamnionitis are present. If Chorio develops, delivery is
indicated regardless of gestational age.
*<34 weeks* - goal is prolongation of pregnancy if no signs of
infection
, OB/GYN - ACOG/UWORLD Exam
Questions & Answers (Grade A+)
- antibiotics (Ampicillin + Erythromycin)
- IM Betamethasone
- *Mag* is usually started <32 weeks for neuroprotection regardless
of presence of preeclampsia (in delivery likely in next 24 hours)
- indocin also started prior to 32 weeks (AE = oligo, PDA closure,
IVH, necrotizing entercolitis)
- Fetal monitoring
- *if signs of fetal infection or compromise* ( --> Abx,
corticosteroids, magnesium if <34 weeks, DELIVERY)
If patient has PROM at 35 weeks and GBS is unknown - do what? -
correct answer ✅Intrapartum IV penicillin should be given -
assume she has it. Normal vaginal flora in ~25% of women.
This really applies to any precipitous labor in which the GBS status
is unknown. Also do it if they have had GBS bactiuria/UTI at any
point in the pregnancy AND/OR have had a previous delivery
complicated by neonatal GBS septicemia/pneumonia/meningitis.
Goal is to get intrapartum IV penicillin on board for 4 hours before
baby's arrival.
