GOBIND SAH

M202001002

**Question 1: What test of the vaginal fluid before a pelvic exam might suggest a higher risk of
preterm birth?**

A test that could indicate a higher risk of preterm birth is the fetal fibronectin (fFN) test. This test looks
for a protein called fibronectin in the vaginal fluid. Fibronectin is normally found in the amniotic fluid
and helps to keep the amniotic sac attached to the uterus. If it's found in the vagina after 22 weeks of
pregnancy, it can mean there's a higher chance of having a baby early in the next two weeks.

**Question 2: If a patient says she's leaking clear fluid from her vagina, what should be done?**

If a patient complains of clear fluid leaking from her vagina, which could be a sign of preterm premature
rupture of membranes (PPROM), here are the steps to take:

1. **Check for Amniotic Fluid**: Do a pelvic exam with a sterile tool to see if there's a pool of fluid in the
vagina. This can be done with a test that changes color if it touches amniotic fluid.

2. **Look for Signs of Infection**: Check the patient for signs of infection, like fever, pain in the belly, or
a bad-smelling discharge. Also, listen to the baby's heartbeat and watch for contractions.

3. **Give Antibiotics**: If it's clear that the amniotic sac has broken (PPROM), give antibiotics to prevent
infection. This is usually a combination of erythromycin and amoxicillin.

4. **Steroids for Lung Maturity**: If the pregnancy is less than 34 weeks along, give steroids to help the
baby's lungs develop.

5. **Treat Contractions**: If the patient isn't already in labor, consider medicine to stop the contractions
if it's safe to do so.

6. **Explain the Options**: Talk to the patient about the choices she has, like waiting for the baby to come
or having the baby sooner.

7. **Keep a Close Eye**: Keep a close watch on the patient for signs of infection, if the baby is in distress,
or if labor starts.

8. **Plan for Delivery**: If labor starts or the baby shows signs of distress, be ready to deliver the baby.

9. **Regular Check-ups**: Set up regular visits to check on the patient and the baby's health.
Here's a simple flow chart to help remember these steps:

Check for amniotic fluid (speculum exam, nitrazine test)

|
Look for signs of infection and monitor fetal heart rate
|
Give antibiotics (erythromycin and amoxicillin)
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Administer steroids if baby is not yet 34 weeks old
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Consider tocolysis if not in active labor and safe to do so
|
Explain options and risks/benefits of waiting vs. delivery
|
Monitor closely for infection, fetal distress, or labor
|

Prepare for delivery if needed

|

Arrange regular follow-up visits