Premature rupture membranes Flashcards
(12 cards)
What is PROM?
premature rupture membranes
spontaneous rupture membranes before labour onset (after 37 weeks)
What causes PROM?
Natural mechanisms
braxton hicks contraction and cervical ripening can lead to weakening of membrane
What is PPROM?
preterm premature rupture
spontaneous rupture before labour but in a pregnancy <37 weeks gestation
What causes PPROM?
weakning of the membranes and is strongly associated with infective causes and certain RF
RF: smokers, STI, previous pprom, multiple pregnancy, cervical incompetence
risk factors of PPROM?
smokers, STI, previous PPROM, multiple pregnancy, cervical incompetence.
Clinical features of rupture of membrane?
Sudden gush of fluid PV
contraction (not painful!)
What are the features of chorioamnionitis?
Maternal pyrexia
maternal tachycardia
fetal tachycardia
+ lower abdo pain, reduced movements, abnormal discharge
How to investigate rupture of membranes
Speculum examination! - pooling of fluid in posterior vaginal vault
2nd line:(if pooling not seen) test fluid for placental alpha microglobulin 1 protein (PAMG-1) OR insulin like growth factor binding protein (IGFBP-1)
What investigation is not done after rupture of membranes
Bimanual - introduces infection
PROM management after 37 weeks is dependent on?
the amniotic fluid observed
PROM speculum exam can show
- clear liquor
- meconium
how to manage both?
Both require: admission to antenatal ward for speculum, 4 hrly temp and 24 hr fetal monitoring
clear : expectant managment for 24 hrs, most with go into labour if not then INDUCE
meconium : Induce labour ASAP
How to manage PPROM (before 37 weeks)
Admission to ward, regular observations to enusre chorio is not developing
- oral erythromycin prophylaxtic 10 days
- IM betamethasone corticosteroid to reduce resp distress syndrome
if birth expected in 24 hrs : IV Mg sulphate
