A 35-year-old G2P1L1 presents to antenatal clinic at 35 weeks of pregnancy with C/O, leaking pervagina. Sample of pooled liquid turned red litmus paper blue and ferning was present.The temperature of the patient is 102degF and her pulse is 104. What is the next step in management?
Ans. is c, i.e Administer antibioticsRef. Williams 23/e, p 819, Fernando Arias 3/e, p 197, 198The fluid in vagina is amniotic fluid, as it showed in fern pattern on microscopy (presence of sodium chloride in liquor) and the red litmus turned blue (vaginal pH is acidic; amniotic fluid is alkaline).This patient with premature rupture of membranes (PROM) has a physical examination consistent with an intrauterine infection or chorioamnionitis.Acute Chorioamniotis is diagnosed clinically in presence of fever (100.4degF or 37.8degC) and at least two of the following:a. Maternal tachycardiab. Fetal tachycardiac. Uterine tendernessd. Foul smelling amniotic fluide. Maternal leukocytosisWhen chorioamnionitis is diagnosed, fetal and maternal morbidities increase and delivery is indicated regardless of the fetus's gestational age. In the case described, labor should be induced and antibiotics to be given to avoid neonatal group of streptococcal infection. Ampicillin is the drug of choice.There is no role for tocolysis in the setting of chorioamnionitis and also because gestational age of patient is 35 weeks, since delivery is the goal: There is also no role for the administration of steroids as it is contraindicated in case of chorioamnionitis.Remember: Management of chorioamnionitis at any age is delivery, regardless of the gestational age.
Administer betamethasone
Administer tocolytics
Administer antibiotics
Place a cervical cerclage
Normal Labour