MedBugs: SAQ #113

Case: Chorioamnionitis

A 35-year-old woman, 27/40 pregnant with twins, self-presents to a small outer metropolitan hospital with PV loss and contractions. She has been placed in resus with full monitoring. Antenatal USS have all been normal. She has no medical history but reports a rash to penicillin. The on-call obstetrician is tied up in OT. A midwife is en route from labour ward. Current vitals : HR 100 SBP 100 RR 18 SpO2 100% RA T 37.7°C.

1. Give (2) assessments which can determine if this patient has had rupture of membranes 2 marks

You confirm rupture of membranes and are concerned for chorioamnionitis as a possible cause.

2. What assessment features would you seek to confirm your diagnosis of chorioamnionitis? 3 marks

The midwife has arrived, commenced CTG monitoring and assessed the patient. Cervix is 4cm dilated.

3. State (3) methods of tocolysis for this patient and briefly state why they are contraindicated 3 marks

You arrange for the patient to be transferred to a specialised obstetric and neonatal centre.

4. State (3) further medications you would consider giving this patient, with justification for each 6 marks

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Case: Chorioamnionitis

1. Give (2) assessments which can determine if this patient has had rupture of membranes 2 marks

2. What assessment features would you seek to confirm your diagnosis of chorioamnionitis? 3 marks

3. State (3) methods of tocolysis for this patient and briefly state why they are contraindicated 3 marks

4. State (3) further medications you would consider giving this patient, with justification for each 6 marks

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