PROM, PPROM and Preterm labor

Question 1

Define prelabor rupture of membranes

Answer 1

Leakage of amniotic fluid in the absence of uterine activity after 37weeks GA

Question 2

Define preterm prelabor rupture of membranes PPROM

Answer 2

Leakage of amniotic fluid before 37weeks GA

Question 3

What causes weakening of membranes x3

Answer 3

Cytokines
Apoptotic markers
Collagen breakdown by enzymes

Question 4

Risk factors of PROM x7

Answer 4

Smoking
Ascending UTI
Previous PROM, PPROM
Cervical incompetence
Multiple gestation
Polyhydramnios
Antepartum hemorrhage

Question 5

Describe tests done to confirm PROM x2

Answer 5

Nitrazine strip- will turn blue ie pH>6 due to urea and creatinine from amniotic fluid

Fern- crystallization due to presence of NaCl in the amniotic fluid

Question 6

State 1 cause of false negative and false positive(1) results on Fern test

Answer 6

Neg- intermittent leaking hence not enough amniotic fluid
Pos- blood contaminated specimen or cervical mucus

Question 7

Risks following PPROM x5

Answer 7

Chorioamnionitis
Neonatal sepsis
Cord prolapse
Preterm labor
Placental abruption

Question 8

Management of PROM x4

Answer 8

Benzyl penicillin
FBC, GxM
Induce or augment labour
C- section

Question 9

Management of PPROM if patient is in labor x2

Answer 9

Benzyl penicillin
Dexamethasone

Question 10

Management of PPROM at 28-34weeks x3

Answer 10

Steroids
Oral erythromycin 250mg Qid x7/7
Deliver at 34 weeks

Question 11

How does PROM cause pulmonary hypoplasia

Answer 11

Leakage of fluid> oligohydramnios> restricted chest wall movement

Question 12

Define chorioamnionitis and 5 features

Answer 12

Infection of the fetal membranes, chorion of placenta and amniotic fluid

Tachycardia, WCC>16,00, fever, foul smelling vaginal discharge, abdominal tenderness

Question 13

Causes of preterm labor x5

Answer 13

Ascending/systemic infection
Stress
Uterine distention
Cervical weakness
Placenta abruption

Question 14

Risk factors of preterm labour x5

Answer 14

Previous preterm
Persistent malaria
High parity
DM, HTN, Anemia

Question 15

Why are tocolytic agents given

Answer 15

To allow antenatal corticosteroid administration and delay delivery by at least 48hrs

Question 16

Tocolytic agents used x3 and when not to use them

Answer 16

Nifedipine - cardiac or renal disease
Salbutamol- cardiac or renal disease
Indomethacin - renal or hepatic disease

Question 17

Pathophysiology of preterm labor x3

Answer 17

1. Overdistension> increased expression of oxytocin and prostaglandin receptors in myometrium
2. Overdistension> activation of fetal endocrine cascade > cortisol> conversion of progesterone to estrogen
3. More MMPs than MMP inhibitors (matrix metalloproteases)

Question 18

Prevention of second trimester losses x2

Answer 18

Cervical cerclage
Progesterone supplements

Question 19

Mode of delivery of chorioamnionitis and why

Answer 19

SVD
Reduced risk of wound infection post CS which can cause systemic infection