0071643192.pdf

OBSTETRICS AND GYNECOLOGY

592

DIAGNOSIS

Confirm PROM with a sterile speculum exam showing:

■ A pool of fluid in the posterior fornix

■ A pH >6.5 (nitrazine paper turns blue!)

■ Ferning of fluid as it dries on a slide; this results from the presence of pro-

teins and electrolytes in the amniotic fluid and is also diagnostic

TREATMENT

■ Immediate OB consultation and admission

■ Test patients for chlamydia, gonorrhea, and group B streptococcus.

■ Prophylactic antibiotics to prevent anminonitis in patients with PROM is

controversial.

PREGNANCY-INDUCED HYPERTENSION

Pregnancy-induced hypertension is defined as BP >140/90 or an increase in

systolic BP >20 (or diastolic >10) above baseline.

Preeclampsia/Eclampsia

Preeclampsia is defined as the presence of new onset hypertension and pro-

teinuria with or without edema in women who are >20 weeks gestation.

Eclampsia = preeclampsia plus seizures.

Risk factors for preeclampsia include:

■ Primigravida

■ Very young or advanced maternal age

■ Diabetes mellitus

■ Multiple gestations

■ Hydatidiform mole

SYMPTOMS

■ Weight gain (>5 pounds/week)

■ Headache/visual disturbances

■ Extremity or facial swelling

■ Shortness of breath

■ Decreased urine output

EXAM

Usually a normal physical exam except for high blood pressure. Edema (peri-

pheral or facial) can be present.

DIFFERENTIAL

■ Gestational hypertension: Mild hypertension after 20 weeks gestation with

no proteinuria present; may progress to preeclampsia, but usually resolves

by 12 weeks postpartum

■ Chronic hypertension (aka preexisting hypertension): Defined as systolic

pressure≥140 mmHg, diastolic pressure ≥90 mmHg, or both, that antedates

pregnancy; present prior to the 20th week, or persists >12 weeks postpartum.

Usually treated with methyldopa (Aldomet), labetalol, or nifedipine;avoid

diuretics and ace inhibitors

Blue nitrazine paper +

ferning = amniotic fluid.

Never ignore an elevated BP

in a pregnant patient.

Eclampsia can kill both the

mother and fetus.