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  #1  
Old 07-27-2012
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ObGyn How to manage this preterm labor!

A 25-year-old woman at 28 weeks gestation comes to the ER because of strong, regular and painful uterine contractions that started 4 hours earlier with the passage of clear fluid from her vagina. She denies any vaginal bleeding. She has had no prenatal care. Vital signs are normal. A sterile speculum examination shows pooling of amniotic fluid within the vagina, and a cervix that is 4 cm dilated and 80% effaced.
Ultrasonogram in the emergency department shows an amniotic fluid index of 4 and bilateral renal agenesis in the fetus. Which of the following is the most appropriate next step in management?

A. Allow spontaneous vaginal delivery
B. Consent for cesarean section
C. Administer corticosteroids
D. Amnioinfusion and tocolysis

*** what will be the answer if instead of fetus having bilateral renal agenesis, fetus is normal on USG. this is case of preterm labor ... so can we give tocolysis then ?
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Old 07-27-2012
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A. Allow spontaneous vaginal delivery

cos the condition isnt viable with life.


if it wasnt the case -- it would be the same PROM/preterm labor workup
1- check for contraindication to continue pregnancy like amnionitis etc
2- check for fetal/maternal well being
3- try uterine relaxants and amnioinfusion etc...
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Old 07-27-2012
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Quote:
Originally Posted by mbbs2010 View Post
A. Allow spontaneous vaginal delivery

cos the condition isnt viable with life.


if it wasnt the case -- it would be the same PROM/preterm labor workup
1- check for contraindication to continue pregnancy like amnionitis etc
2- check for fetal/maternal well being
3- try uterine relaxants and amnioinfusion etc...
Isn't this just preterm labor with PROM?

there's nothing written about infection or abruption or fetal distress so why not try tocolysis before delivering the baby? it has renal agenesis probably because of uteroplacental insufficiency since there is also ROM and oligohydramnios
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Old 07-28-2012
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Quote:
Originally Posted by gunner0101 View Post
it has renal agenesis probably because of uteroplacental insufficiency since there is also ROM and oligohydramnios
the child has renal agenesis ----that may be the cause of oligohydramnios. --YES


but since the condition is not compatible with life ---- there is no point in continuing the pregnancy to term.
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Old 07-28-2012
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Yeah, the oligohydramnios is caused by the renal agenesis, not the other way around. If the oligohydramnios was caused by the PROM, it would take at least several days/weeks before you'd notice any fetal abnormalities secondary to oligohydramnios.

If the baby was normal, then you'd probably give tocolysis and corticosteroids, possibly with amnioinfusion... but amnioinfusion may not be necessary if the baby doesn't have any kidney problems.
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Old 07-29-2012
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It should be A..

If it were a normal fetus then check for any signs of fetal or maternl deterioration and ten go for amnioinfusion also chkfor pprom infection
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