Dx
How soon do you repeat temperature to make a diagnosis of Triple I?
30 minutes
Triple I alone is an indication for cesarean delivery (T or F)
False BABY, FALSE!!!!
FREE 100
What is another name for intraamniotic infection?
Chorioamnionitis
Suspected intraamniotic infection is based on clinical criteria including.... (at least 2)
- maternal fever + one of the following (leukocytosis, purulent cervical drainage, fetal tachycardia)
Antibiotics should be considered in the setting of isolated maternal fever (T or F)
True; antibiotics should be considered in the setting of isolated maternal fever unless a sources other than intraamniotic infection is identified and documented
Name 3 obstetrical risk factors at term for Tripe I
Low parity, multiple cervical checks (chill out 0_0), , internal uterine and fetal monitors (FSE, IUPC), meconium, GBS+, STIs
Define Triple I
Infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes or decidua
What are the diagnostic criteria for Triple I (temperature)
Maternal fever >/= 102.2F (39C)
(OR)
Maternal fever 100.4-102.02 (38-38.9C) + additional clinical risk factor
Name the primary recommended Ab to treat suspected or confirmed Triple I and their dosage
Ampicillin (2gIV q6)
AND
Gentamicin 2mg/kg IV load fb 1.5mg/kg q8
OR 5 mg/kg IV q24
Name a procedure that can have an increased risk of Triple I
Amniocentesis, chorionic villous sampling
Are Triple I's typically caused by anaerobic or aerobic bacteria?
Both and is typically polymicrobial. Frequently originates from the vaginal flora and predominantly occurs by ascending bacterial invasion from the lower genital tract to the amniotic cavity
What is an isolated maternal fever?
Temp between 100.4-102.02 (38-38.9C) w/ no additional risk factors
Under what circumstances should you consider postpartum antibiotics
s/p cesarean delivery at least one additional dose (recommended)
increased risk for postpartum endometritis
Presence of other maternal risk factors PP (bacteremia, persistent fever, duration of Ab therapy)
Name at least 3 neonatal morbidities resulting from Triple I
* Neonatal pneumonia, meningitis, sepsis, death, bronchopulmonary dysplasia, cerebral palsy
What percent of term deliveries are complicated by a clinically apparent Triple I
2-5%
What are some ways to definitively diagnose Triple I (not clinically)
Amniotic fluid culture, Gram stain, Biochemical analysis, placenta histology indicating infection or inflammation
Recommended Ab TX for Triple I in a patient with mild penicillin allergy
Cefazolin (2gIV q8)
AND
Gentamicin (2g/kg IV load fb 1.5mg/kg q8)
OR 5 mg/kg IV q24
Name 3 maternal morbidities from Tripe I
dysfunctional labor req. increased intervention, PP uterine atony w/ hemorrhage, endometritis, peritonitis, sepsis, ARDS, rarely death (spooooooky stuff)
Recommended Ab tx for Triple I in a patient with severe PCN allergy
Clindamycin 900 mg IV q8
OR
Vancomycin (1gIV q12) AND Gent (2mg/kg IV load fb 1.5 mg/kg q8 OR 5 mg/kg IV q24)