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OB-GYN (A.G.) > Abnormal Rupture of Membranes > Flashcards

Abnormal Rupture of Membranes Flashcards

1
Q

When does rupture of membranes typically occur?

A

1st stage of labour

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2
Q

What is premature rupture of membranes (PROM)?

A

rupture of membranes before onset of labor (usually more than 1h before), at term

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3
Q

What are the 3 classifications of abnormal rupture of membranes?

A
  1. premature rupture of membranes (PROM)
  2. prolonged rupture of membranes
  3. preterm premature rupture of membranes (PPROM)
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4
Q

Should digital vaginal exam of the cervix be done to a patient with suspected PROM? Why?

A

No, a digital exam should NOT be done to a patient with rupture of membranes before the begining of the active phase, because this would increase risk of infection and shorten the latence phase.

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5
Q

What questions should you ask a patient presenting with fluid gush?

A

When?
What colour: pale, dark, bloody?
Is the gush persisting (i.e. still leaking)?
How much?

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6
Q

What physical exam should be done when a patient presents with potential loss of amniotic fluid (perte de liquide amniotique)?
What should be found if it really is a rupture of membranes?

A
  1. Sterile speculum exam (NO DIGITAL EXAM if patient not in active phase): pooling of liquid on posterior fornix or fluid leaking from cervix during coughing or valsalva manoeuvers
  2. Nitrazine test (= Litmus test): the test strip should turn blue / green if it is amniotic fluid (because pH more than 6.5 and amniotic fluid is alkaline)
  3. Fern test: positive if amniotic fluid, i.e. fern / snowflake pattern on microscope slide
  4. Ultrasound: oligohydraminos (low amniotic fluid level) may be found, rule out fetal anomalies if no prior ultrasound
    (5. Rapid test: positive IGF-1 in cervix and/or positive placental a-microglobulin-1 (PAMG-1) in cervicovaginal fluid.)
    *Ensure foetal wellbeing (by ultrasound or foetal reactivity test = non stress test)
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7
Q

How is a fern test done? What is a positive result?

A

Vaginal fluid from the posterior fornix is gathered and spread on a slide, and allowed to dry for 10 minutes before looking under a microscope.
A positive fern test, i.e. presence of amniotic fluid, is with finding of a fern-like pattern on microscope slide.

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8
Q

Is the nitrazine test specific?

A

No, can be positive with blood, urine and/or semen also

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9
Q

What is prolonged rupture of membranes?

A

rupture of membranes occurs more than 18hrs before onset of labour, in term or preterm pregnancies

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10
Q

What is the definition of labour?

A

regular and painful uterine contractions that cause progressive dilatation and effacement of the cervix

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11
Q

What is preterm premature rupture of membranes (PPROM)?

A

preterm (before 37wks GA) AND PROM

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12
Q

What are risk factors for PROM?

A
  1. ascending infection
  2. personal or family history of PROM or preterm delivery
  3. multiparity
  4. tabagism
  5. cervical incompetence
  6. congenital anomaly
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13
Q

What are risk factors for PPROM?

A

risk factors for PROM + previous PPROM

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14
Q

What are the complications of PROM?

A
  1. intra-uterine infection (chorioamnionitis)
  2. premature delivery
  3. pulmonary hypoplasia
  4. intraventricular hemorrage
  5. cord prolapse
  6. limb contracture
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15
Q

Indications for urgent delivery?

A
  1. fetal distress
  2. chorioamnionitis
  3. placental abruption
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16
Q

What investigations (conduite à tenir) should be done to a patient presenting with PROM?

A
  • admit
  • monitor vitals q 4hrs
  • daily non stress test
  • white blood cell count
  • watch for infection: screen for UTIs, STIs, GBS (treat GBS at time of labour)
  • consider: 1. betamethasone to accelerate maturity if GA under 35 wks and no infection 2. tocolysis (mx that lowers uterine contractions) for 48hrs to allow administration of steroids (for induction of fetal lung maturation) if probable premature induction of labour 3. antibiotics if no labour indicated (penicillins or macrolides)
17
Q

General management of PROM based on GA?

A

Under 24wks GA: expectant management VS termination of pregnancy
24 to 34wks GA: expectant management + steroids + prophylactic antibiotics + tocolysis? + magnesium sulfate (for foetal neuroprotection)?
34 to 37wks GA: grey zone - expectant management VS induction of labour consider on a case to case basis
37wks GA and more: induction of labour

OB-GYN (A.G.) (7 decks)

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