Podcast
Questions and Answers
What is a strong recommendation when GBS status is unknown and one or more intrapartum risk factors are present?
What is a strong recommendation when GBS status is unknown and one or more intrapartum risk factors are present?
- Expectant management should be preferred over any intervention.
- Corticosteroids should be administered to the mother.
- Intrapartum antibiotic prophylaxis (IAP) should be offered. (correct)
- Induction of labor should be immediately initiated.
What does the evidence suggest about induction of labor for GBS-positive clients experiencing PROM?
What does the evidence suggest about induction of labor for GBS-positive clients experiencing PROM?
- Induction is required for all clients regardless of PROM duration.
- Induction leads to higher rates of maternal complications.
- Induction may reduce cases of neonatal infection compared to expectant management. (correct)
- Induction is not recommended under any circumstances.
For GBS-positive clients who experience PROM for less than 18 hours and have no other risk factors, what is the recommended approach?
For GBS-positive clients who experience PROM for less than 18 hours and have no other risk factors, what is the recommended approach?
- Only expectant management is appropriate.
- Mandate immediate cesarean section.
- Offer a choice between expectant management and immediate induction. (correct)
- Induction should be strongly encouraged regardless of circumstances.
Which statement about IAP timing for GBS-positive pregnant individuals with PROM is true?
Which statement about IAP timing for GBS-positive pregnant individuals with PROM is true?
What recommendation is made for clients who are GBS positive and experience PROM for 18 hours or more?
What recommendation is made for clients who are GBS positive and experience PROM for 18 hours or more?
What is the recommended minimum observation period for well-appearing newborns exposed to chorioamnionitis?
What is the recommended minimum observation period for well-appearing newborns exposed to chorioamnionitis?
How does the duration of Intrapartum Antibiotic Prophylaxis (IAP) affect the risk of early-onset GBS disease?
How does the duration of Intrapartum Antibiotic Prophylaxis (IAP) affect the risk of early-onset GBS disease?
According to the latest guidance, when is a CBC particularly helpful for assessing newborns?
According to the latest guidance, when is a CBC particularly helpful for assessing newborns?
What approach is suggested for infants with multiple risk factors for sepsis?
What approach is suggested for infants with multiple risk factors for sepsis?
What is indicated about the effectiveness of expectant observation compared to laboratory testing?
What is indicated about the effectiveness of expectant observation compared to laboratory testing?
What should parents understand before their well-appearing baby is discharged after 24 hours?
What should parents understand before their well-appearing baby is discharged after 24 hours?
What does the guidance suggest for infants born to GBS-positive parents with adequate IAP and no other risk factors?
What does the guidance suggest for infants born to GBS-positive parents with adequate IAP and no other risk factors?
How often should vital signs be monitored in the first 24 hours for at-risk infants?
How often should vital signs be monitored in the first 24 hours for at-risk infants?
What should midwives discuss with all clients regarding newborn transition in the first 24 hours?
What should midwives discuss with all clients regarding newborn transition in the first 24 hours?
Which symptom would NOT typically indicate possible sepsis in a newborn?
Which symptom would NOT typically indicate possible sepsis in a newborn?
What immediate action should a midwife take if EOGBSD is suspected?
What immediate action should a midwife take if EOGBSD is suspected?
What factor is strongly predictive of early-onset group B streptococcus disease (EOGBSD) in neonates?
What factor is strongly predictive of early-onset group B streptococcus disease (EOGBSD) in neonates?
What should midwives do when signs of sepsis are noted during an in-person examination?
What should midwives do when signs of sepsis are noted during an in-person examination?
What does IAP stand for in the context of newborn care?
What does IAP stand for in the context of newborn care?
Why might routine laboratory testing not be compared with expectant observation for asymptomatic newborns in a specific study?
Why might routine laboratory testing not be compared with expectant observation for asymptomatic newborns in a specific study?
What is a critical factor to communicate to parents about contacting a midwife?
What is a critical factor to communicate to parents about contacting a midwife?
What maternal condition is indicated by a temperature greater than 38°C during labor?
What maternal condition is indicated by a temperature greater than 38°C during labor?
Which statement about midwives' roles is true regarding newborn care management decisions?
Which statement about midwives' roles is true regarding newborn care management decisions?
How often do studies indicate that septic infants present within the first 24 hours of life?
How often do studies indicate that septic infants present within the first 24 hours of life?
What is a key consideration in offering IAP options to GBS-positive clients with PROM?
What is a key consideration in offering IAP options to GBS-positive clients with PROM?
Which of the following factors may affect the assessment of neonates for EOGBSD?
Which of the following factors may affect the assessment of neonates for EOGBSD?
Why is it important for parents to be educated about signs of illness in their newborns?
Why is it important for parents to be educated about signs of illness in their newborns?
What is a characteristic of EOGBSD related to its occurrence?
What is a characteristic of EOGBSD related to its occurrence?
What is the purpose of assessing clinical signs in neonates for EOGBSD?
What is the purpose of assessing clinical signs in neonates for EOGBSD?
Which symptom is commonly associated with EOGBSD?
Which symptom is commonly associated with EOGBSD?
What should midwives consider when managing GBS-positive clients?
What should midwives consider when managing GBS-positive clients?
What is the significance of the recommendation about the timing of IAP for PROM?
What is the significance of the recommendation about the timing of IAP for PROM?
When should immediate assessment and consultation be initiated for a neonate?
When should immediate assessment and consultation be initiated for a neonate?
In what way can midwives support parents during the neonatal period?
In what way can midwives support parents during the neonatal period?
Which clients should be offered Intrapartum Antibiotic Prophylaxis (IAP)?
Which clients should be offered Intrapartum Antibiotic Prophylaxis (IAP)?
What is a significant risk factor for early-onset GBS disease?
What is a significant risk factor for early-onset GBS disease?
What is the first-line antibiotic treatment for a GBS-positive client in labor?
What is the first-line antibiotic treatment for a GBS-positive client in labor?
Which of the following is a risk factor for neonatal infection associated with GBS?
Which of the following is a risk factor for neonatal infection associated with GBS?
In which scenario should clindamycin be prescribed as an alternative antibiotic?
In which scenario should clindamycin be prescribed as an alternative antibiotic?
What does heavy colonization with GBS correlate with in terms of pregnancy outcomes?
What does heavy colonization with GBS correlate with in terms of pregnancy outcomes?
Which maternal condition indicates a need for IAP during labor?
Which maternal condition indicates a need for IAP during labor?
What does the term EOGBSD stand for and why is it important?
What does the term EOGBSD stand for and why is it important?
What is an associated symptom of late-onset GBS disease in newborns?
What is an associated symptom of late-onset GBS disease in newborns?
What is the recommended gestational period for screening women for group B streptococcus (GBS) colonization?
What is the recommended gestational period for screening women for group B streptococcus (GBS) colonization?
Which of the following groups of women should receive intravenous antibiotic prophylaxis for GBS?
Which of the following groups of women should receive intravenous antibiotic prophylaxis for GBS?
What is the minimum observation period for women < 37 weeks’ gestation in labor if they have an unknown GBS status?
What is the minimum observation period for women < 37 weeks’ gestation in labor if they have an unknown GBS status?
If the GBS colonization status is unknown and membranes have been ruptured for more than 18 hours at ≥ 37 weeks’ gestation, what should be administered?
If the GBS colonization status is unknown and membranes have been ruptured for more than 18 hours at ≥ 37 weeks’ gestation, what should be administered?
What should be done if more than five weeks have elapsed since the initial GBS swab culture?
What should be done if more than five weeks have elapsed since the initial GBS swab culture?
What is the recommended method for collecting a GBS culture?
What is the recommended method for collecting a GBS culture?
Which scenario does NOT warrant antibiotic prophylaxis for GBS during labor?
Which scenario does NOT warrant antibiotic prophylaxis for GBS during labor?
Why might a client be instructed on how to perform their own GBS swab?
Why might a client be instructed on how to perform their own GBS swab?
What is the significance of heavy colonization of GBS?
What is the significance of heavy colonization of GBS?
What action should be taken for women with pre-labor rupture of membranes at < 37 weeks’ gestation who have a positive GBS culture status?
What action should be taken for women with pre-labor rupture of membranes at < 37 weeks’ gestation who have a positive GBS culture status?
What is the primary purpose of assessing fetal heart rate (FHR) characteristics during electronic fetal monitoring (EFM)?
What is the primary purpose of assessing fetal heart rate (FHR) characteristics during electronic fetal monitoring (EFM)?
Which understanding is crucial when interpreting abnormal fetal heart rate patterns?
Which understanding is crucial when interpreting abnormal fetal heart rate patterns?
What does 'baseline variability' in fetal heart rate monitoring indicate?
What does 'baseline variability' in fetal heart rate monitoring indicate?
What should be established first when initiating electronic fetal monitoring?
What should be established first when initiating electronic fetal monitoring?
What classification applies when there is no evidence of fetal compromise?
What classification applies when there is no evidence of fetal compromise?
What was the main finding regarding cesarean section rates between IA and EFM for low-risk healthy women?
What was the main finding regarding cesarean section rates between IA and EFM for low-risk healthy women?
Which method of fetal surveillance is recommended for low-risk pregnancies upon admission to triage?
Which method of fetal surveillance is recommended for low-risk pregnancies upon admission to triage?
What is one potential outcome of using EFM monitoring in low-risk populations?
What is one potential outcome of using EFM monitoring in low-risk populations?
In both studies mentioned, what was a common intervention for women allocated to admission EFM?
In both studies mentioned, what was a common intervention for women allocated to admission EFM?
For what type of patients is admission EFM recommended?
For what type of patients is admission EFM recommended?
What was the cesarean section rate found for the IA group in the Smith et al. study?
What was the cesarean section rate found for the IA group in the Smith et al. study?
Which group of women does the Canadian decision advocate for using admission IA?
Which group of women does the Canadian decision advocate for using admission IA?
What outcome did the 2018 multicentre randomized trial by Smith et al. specifically show regarding the use of EFM?
What outcome did the 2018 multicentre randomized trial by Smith et al. specifically show regarding the use of EFM?
Why is the use of admission EFM not recommended for healthy, term patients presenting in labor?
Why is the use of admission EFM not recommended for healthy, term patients presenting in labor?
What is a primary characteristic defining low-risk pregnancies based on the recommendations?
What is a primary characteristic defining low-risk pregnancies based on the recommendations?
What is the recommended frequency for assessments during the latent phase of labor?
What is the recommended frequency for assessments during the latent phase of labor?
When should more frequent assessments of fetal heart rate (FHR) be considered?
When should more frequent assessments of fetal heart rate (FHR) be considered?
What is the minimum assessment frequency during the active phase of labor?
What is the minimum assessment frequency during the active phase of labor?
What should be done if there are atypical changes in fetal heart rate or other changes during labor?
What should be done if there are atypical changes in fetal heart rate or other changes during labor?
In the passive phase of the second stage of labor, what is the minimum recommended assessment frequency?
In the passive phase of the second stage of labor, what is the minimum recommended assessment frequency?
Why might internal monitoring of fetal heart rate (FHR) be necessary?
Why might internal monitoring of fetal heart rate (FHR) be necessary?
What is indicated by the presence of atypical and abnormal fetal heart rate patterns?
What is indicated by the presence of atypical and abnormal fetal heart rate patterns?
How should assessments be individualized during labor?
How should assessments be individualized during labor?
What is one characteristic of artifact from external ultrasound in monitoring fetal heart rate?
What is one characteristic of artifact from external ultrasound in monitoring fetal heart rate?
When confronted with uninterpretable FHR tracing, which step should NOT be taken?
When confronted with uninterpretable FHR tracing, which step should NOT be taken?
What does an artifact from an internal fetal spiral electrode typically look like?
What does an artifact from an internal fetal spiral electrode typically look like?
Which method is effective for clarifying ambiguous FHR readings?
Which method is effective for clarifying ambiguous FHR readings?
What should be the primary concern when assessing FHR for fetal arrhythmia?
What should be the primary concern when assessing FHR for fetal arrhythmia?
What is a common troubleshooting step if the FHR tracing is uninterpretable?
What is a common troubleshooting step if the FHR tracing is uninterpretable?
In fetal heart rate monitoring, inappropriate artifact identification can lead to what major issue?
In fetal heart rate monitoring, inappropriate artifact identification can lead to what major issue?
If repositioning transducers does not yield a clear signal, which option should be considered next?
If repositioning transducers does not yield a clear signal, which option should be considered next?
What initial step should be taken if an artifact is suspected in the FHR tracing?
What initial step should be taken if an artifact is suspected in the FHR tracing?
What factor should always be considered when interpreting the findings from Electronic Fetal Monitoring (EFM)?
What factor should always be considered when interpreting the findings from Electronic Fetal Monitoring (EFM)?
Which of the following is NOT a perinatal risk factor that indicates the need for Intrapartum Electronic Fetal Monitoring?
Which of the following is NOT a perinatal risk factor that indicates the need for Intrapartum Electronic Fetal Monitoring?
What is an indication for using Electronic Fetal Monitoring during labor?
What is an indication for using Electronic Fetal Monitoring during labor?
What maternal perception may warrant the use of Electronic Fetal Monitoring?
What maternal perception may warrant the use of Electronic Fetal Monitoring?
Which of the following conditions is associated with abnormal findings that necessitate the use of Electronic Fetal Monitoring?
Which of the following conditions is associated with abnormal findings that necessitate the use of Electronic Fetal Monitoring?
Which of the following is a condition that may lead to the recommendation of Electronic Fetal Monitoring?
Which of the following is a condition that may lead to the recommendation of Electronic Fetal Monitoring?
What does the Society of Obstetricians and Gynecologists of Canada recommend regarding the use of EFM?
What does the Society of Obstetricians and Gynecologists of Canada recommend regarding the use of EFM?
Which abnormal condition specifically suggests the need for Electronic Fetal Monitoring?
Which abnormal condition specifically suggests the need for Electronic Fetal Monitoring?
In the context of EFM, what should be done when abnormal fetal heart rate (FHR) patterns are observed?
In the context of EFM, what should be done when abnormal fetal heart rate (FHR) patterns are observed?
What is an applicable reason for initiating EFM when maternal health is compromised?
What is an applicable reason for initiating EFM when maternal health is compromised?
Flashcards
EOGBSD
EOGBSD
Early-onset group B Streptococcus disease, a serious bacterial infection in newborns.
Clinical Monitoring
Clinical Monitoring
Regular observation of a newborn's health signs (vital signs, etc.).
Chorioamnionitis
Chorioamnionitis
Inflammation of the membranes surrounding the fetus.
Expectant observation
Expectant observation
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CBC
CBC
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IAP
IAP
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24-hour observation
24-hour observation
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Sepsis
Sepsis
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GBS Status
GBS Status
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Signs of Sepsis
Signs of Sepsis
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Clinical Evaluation
Clinical Evaluation
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Routine Laboratory Testing
Routine Laboratory Testing
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Management Strategies for Chorioamnionitis
Management Strategies for Chorioamnionitis
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Intrapartum Fever
Intrapartum Fever
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EOGBSD Risk Factor
EOGBSD Risk Factor
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IAP for PROM
IAP for PROM
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IAP Timing
IAP Timing
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EOGBSD Prevention Limitation
EOGBSD Prevention Limitation
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Recognizing EOGBSD
Recognizing EOGBSD
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EOGBSD Symptoms
EOGBSD Symptoms
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EOGBSD Progression
EOGBSD Progression
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EOGBSD Assessment
EOGBSD Assessment
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EOGBSD Monitoring
EOGBSD Monitoring
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EOGBSD Parental Involvement
EOGBSD Parental Involvement
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GBS status unknown, risk factors
GBS status unknown, risk factors
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Term PROM, GBS positive, < 18 hours
Term PROM, GBS positive, < 18 hours
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Term PROM, GBS positive, ≥ 18 hours
Term PROM, GBS positive, ≥ 18 hours
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Induction vs. Expectant Management
Induction vs. Expectant Management
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Optimal Timing of IAP for PROM
Optimal Timing of IAP for PROM
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GBS Screening
GBS Screening
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GBS Culture
GBS Culture
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Intravenous Antibiotic Prophylaxis
Intravenous Antibiotic Prophylaxis
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GBS Positive
GBS Positive
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Premature Rupture of Membranes (PROM)
Premature Rupture of Membranes (PROM)
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GBS Status Unknown
GBS Status Unknown
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Management of PROM
Management of PROM
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Re-screening for GBS
Re-screening for GBS
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Interval Between Culture and Birth
Interval Between Culture and Birth
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Client-Performed Swab
Client-Performed Swab
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What are the 3 approaches to IAP?
What are the 3 approaches to IAP?
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Culture-screening approach
Culture-screening approach
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Risk-factor approach
Risk-factor approach
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Combined approach
Combined approach
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Early-onset GBS disease (EOGBSD)
Early-onset GBS disease (EOGBSD)
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Late-onset GBS disease (LOGBSD)
Late-onset GBS disease (LOGBSD)
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What are some risk factors for EOGBSD?
What are some risk factors for EOGBSD?
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IAP effectiveness
IAP effectiveness
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Penicillin G
Penicillin G
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Alternatives to penicillin
Alternatives to penicillin
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Fetal Heart Rate (FHR) Monitoring Frequency
Fetal Heart Rate (FHR) Monitoring Frequency
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Labor Stages and FHR Monitoring
Labor Stages and FHR Monitoring
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Monitoring Abnormal FHR
Monitoring Abnormal FHR
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FHR Monitoring and Maternal-Fetal Status
FHR Monitoring and Maternal-Fetal Status
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The Purpose of FHR Monitoring
The Purpose of FHR Monitoring
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When to Increase FHR Monitoring
When to Increase FHR Monitoring
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Continuous Monitoring
Continuous Monitoring
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FHR Assessment Importance
FHR Assessment Importance
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Artifact from external ultrasound
Artifact from external ultrasound
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Artifact from internal fetal spiral electrode
Artifact from internal fetal spiral electrode
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Troubleshooting uninterpretable tracings
Troubleshooting uninterpretable tracings
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Differentiating fetal and maternal heart rate
Differentiating fetal and maternal heart rate
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Evidence of fetal arrhythmia
Evidence of fetal arrhythmia
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Fetal heart rate (FHR) variability
Fetal heart rate (FHR) variability
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External monitoring
External monitoring
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Internal monitoring
Internal monitoring
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Auscultation
Auscultation
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Repositioning transducers
Repositioning transducers
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Admission EFM
Admission EFM
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When is admission EFM recommended?
When is admission EFM recommended?
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IA for low-risk pregnancies
IA for low-risk pregnancies
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Benefits of IA
Benefits of IA
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EFM in low-risk pregnancies
EFM in low-risk pregnancies
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Fetal surveillance
Fetal surveillance
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Intermittent Auscultation (IA)
Intermittent Auscultation (IA)
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Continuous EFM
Continuous EFM
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Fetal Heart Rate (FHR) Assessment
Fetal Heart Rate (FHR) Assessment
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Frequency of FHR Assessment
Frequency of FHR Assessment
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EFM Indication: Hypertensive Disorders
EFM Indication: Hypertensive Disorders
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EFM Indication: Pre-pregnancy BMI
EFM Indication: Pre-pregnancy BMI
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EFM Indication: Diabetes
EFM Indication: Diabetes
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EFM Indication: Fetal Movement Reduction
EFM Indication: Fetal Movement Reduction
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EFM Indication: Intrauterine Growth Restriction (IUGR)
EFM Indication: Intrauterine Growth Restriction (IUGR)
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EFM Indication: Abnormal Umbilical Artery Doppler
EFM Indication: Abnormal Umbilical Artery Doppler
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EFM Indication: Oligohydramnios
EFM Indication: Oligohydramnios
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EFM Indication: Previous Cesarean Section
EFM Indication: Previous Cesarean Section
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EFM Indication: Prolonged Rupture of Membranes
EFM Indication: Prolonged Rupture of Membranes
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EFM Indication: Labor Dystocia
EFM Indication: Labor Dystocia
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What are the steps in systematic EFM interpretation?
What are the steps in systematic EFM interpretation?
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What are the parts of an EFM tracing?
What are the parts of an EFM tracing?
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Why is baseline variability important?
Why is baseline variability important?
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What are accelerations?
What are accelerations?
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What are decelerations?
What are decelerations?
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Study Notes
Group B Streptococcus (GBS) Summary
- This document provides a summary of the most essential content of the AOM CPG No. 19, focusing on antepartum, intrapartum, and postpartum management of GBS.
- The prevalence of GBS colonization in pregnant individuals ranges from 15% to 40%, variable across populations and testing methods.
- In Ontario (2019), approximately 19% of pregnant people screened for GBS between 35 and 37 weeks' gestation had a positive result.
- Early-onset GBS (EOGBSD) occurs within the first 7 days of life and was estimated at 3/1000 live births before widespread intrapartum antibiotic prophylaxis (IAP) in the 1980s.
- In 2019, Ontario saw only 35 cases of EOGBSD, representing a rate of 0.23 per 1000 live births.
Understanding GBS Prevalence, Incidence, and Complications
-
Untreated, 40% to 70% of babies born to GBS-positive mothers may become colonized.
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15% to 40% of pregnant individuals are GBS positive.
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1% to 2% of colonized babies develop an infection if untreated.
-
5% of babies with developed infections die.
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In a group of 50,000 pregnant people, an estimated 7,500 to 20,000 would be colonized with GBS.
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In the same group, 3,000 to 14,000 babies would be colonized with GBS.
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30 to 280 babies might develop infections, with related breakdown by types: bacteremia (19–232), pneumonia (3–64), and meningitis (2–35).
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2 to 14 babies might die from GBS infection.
Risk Factors for GBS Colonization
- Colonization in a prior pregnancy is a strong predictor for colonization (OR 5.80).
- Pregestational diabetes is a moderate predictor (OR 1.34).
- Gestational diabetes has a weaker predictive effect (OR 1.17)
- BMI over 25kg/m2 increases colonization likelihood (OR 1.21).
Risk Factors for EOGBSD in Newborns
- A previous infant with EOGBSD is a strong predictor (OR 27.81).
- GBS-positive parent is also a powerful predictor (OR 10.44).
- Frequent vaginal exams raise EOGBSD likelihood (OR 6.32).
- GBS bacteriuria augments the likelihood (OR 5.34).
- Chorioamnionitis may increase the likelihood (OR 4.19).
- Intrapartum fever may increase the likelihood (OR 3.62).
- Membrane sweeping slightly increases EOGBSD likelihood (OR 2.52).
- Preterm birth (<37 weeks) is a significant predictor (OR 2.02).
- Prolonged rupture of membranes (PROM) >18 hours may increase likelihood.
- Low birth weight (<2500 g) slightly increases likelihood (OR 2.01).
- Multiple pregnancies slightly increase the likelihood (OR 1.98).
Antibiotic Prevention of GBS Colonization
- Studies suggest that the use of oral probiotics near delivery can reduce GBS colonization.
- Some studies suggest that vaginal-rectal swabs are highly specific (90%) and sensitive (77%) in identifying GBS in pregnancy.
- Observation intervals of greater than 6 weeks between sampling and birth may reduce accuracy of results.
- Self-collection swabs can be an option.
Timing of Screening and Diagnosis
- Offer GBS screening at 35–37 weeks of gestation, with vaginal-rectal cultures.
- Consider re-screening clients after an interval of 5 weeks if delivery has not taken place.
Facilitating Decisions with Clients
- Provide general information about GBS and the implications of a positive GBS result to the clients.
- Allow time for questions and concerns.
- Discuss treatment options, risks, and client preferences.
Studying That Suits You
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Description
This quiz provides a comprehensive summary of the management of Group B Streptococcus (GBS) based on AOM CPG No. 19. It discusses the prevalence, incidence, and complications associated with GBS in pregnant individuals, including the impact on newborns. Test your knowledge on crucial aspects of GBS screening, intrapartum care, and outcomes for infants.
