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This document discusses premature rupture of membranes (PROM). PROM occurs when the amniotic sac breaks before the onset of labor. It is diagnosed by a gush of fluid from the vagina or pooling of fluid in the vagina. Management depends on gestational age and presence of infection. If infection is present, delivery is recommended regardless of gestational age. For term pregnancies without infection, expectant management for 6-12 hours before inducing labor is acceptable. For preterm pregnancies between 24-32 weeks, antibiotics and corticosteroids are recommended along with limiting tocolytics to 48 hours.
This document discusses premature rupture of membranes (PROM). PROM occurs when the amniotic sac breaks before the onset of labor. It is diagnosed by a gush of fluid from the vagina or pooling of fluid in the vagina. Management depends on gestational age and presence of infection. If infection is present, delivery is recommended regardless of gestational age. For term pregnancies without infection, expectant management for 6-12 hours before inducing labor is acceptable. For preterm pregnancies between 24-32 weeks, antibiotics and corticosteroids are recommended along with limiting tocolytics to 48 hours.
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This document discusses premature rupture of membranes (PROM). PROM occurs when the amniotic sac breaks before the onset of labor. It is diagnosed by a gush of fluid from the vagina or pooling of fluid in the vagina. Management depends on gestational age and presence of infection. If infection is present, delivery is recommended regardless of gestational age. For term pregnancies without infection, expectant management for 6-12 hours before inducing labor is acceptable. For preterm pregnancies between 24-32 weeks, antibiotics and corticosteroids are recommended along with limiting tocolytics to 48 hours.
Copyright:
Attribution Non-Commercial (BY-NC)
Formati disponibili
Scarica in formato PDF, TXT o leggi online su Scribd
KABERA René, MD Resident PGY II- Family and Community Medicine Obs-Gyn. Dept Ruhengeri Hospital Feb 2010. ESSENTIALS OF DIAGNOSIS
• History of a gush of fluid from the vagina or
watery vaginal discharge.
• Demonstration of amniotic fluid leakage from
the cervix. • ≥1h before the onset of labor.
KABERA René ,MD PGY II FAMCO NUR
General Considerations
• Rupture of the membranes may happen at
any time during pregnancy. • It becomes a problem if the fetus is preterm (preterm) . • >24 Hrs, prolonged premature rupture of membranes -time between rupture of the membranes and the onset of labor is.
KABERA René ,MD PGY II FAMCO NUR
General considerations c’t • Causes Infections . Cervix incompetency. Hydramnios … • 10.7 % in all pregnancy. • 94% mature fetus (>2500 grs) ,5% premature fetus (1000-2500 grs),immature fetus 0.5%(<1000 grs). KABERA René ,MD PGY II FAMCO NUR Pathophysiology • PROM is an important cause of preterm labor, prolapse of the cord, placental abruption, and intrauterine infection. • In extremely prolonged PROM, the fetus may have an appearance similar to that of Potter's syndrome (eg, extraordinary flexion, wrinkling of the skin). • If PROM occurs at less than 26 weeks' EGA, it can cause pulmonary hypoplasia and limb positioning defects in the newborn. KABERA René ,MD PGY II FAMCO NUR Clinical findings • Symptoms • The patient usually reports a sudden gush of fluid or continued leakage. • Reduced size of the uterus, and increased prominence of the fetus to palpation. • Sterile Speculum Examination • Pooling , Nitrazine test, Ferning.
KABERA René ,MD PGY II FAMCO NUR
Lab test • CBC , CRP, U/S, Amniocentesis for lung maturation • Amniotitis : most common germ is streptococci B-fever ,leukocytosis (>16000 WBC),uterine tenderness, tachycardia ( >100 btm-mother,>160 btm-fetus ),foul smelling amniotic liquid .
KABERA René ,MD PGY II FAMCO NUR
Management • A.Amniotitis : delivery regardless of gestational age. Broad- spectrum antibiotics should be started. if no labor , labor should be induced to expedite delivery. • B. Term Pregnancy Without Amnionitis: • Nonintervention is an acceptable initial course of treatment, but if the patient does not go into labor within 6-12 hours after PROM, labor should be induced to minimize the risk of infection. KABERA René ,MD PGY II FAMCO NUR Management c’t • C. Preterm Pregnancy Without Amnionitis Pregnancies beyond 33-34 weeks' EGA can be managed as a term pregnancy because there is no evidence that antibiotics, corticosteroids, or tocolytics improve outcome in these patients.
• Pregnancies prior to 24 weeks' EGA with PROM have
extremely low rates of fetal salvage with considerable maternal risk. Furthermore, at this early gestational age, steroids, tocolytics, and antibiotics have no proven benefit. KABERA René ,MD PGY II FAMCO NUR Management c’t • For pregnancies with PROM between 24 and 32 weeks' EGA. • Antibiotics. • Corticosteroids. • Tocolytics :In the preterm PROM patient should be limited to 48 hours duration.
KABERA René ,MD PGY II FAMCO NUR
References • Current Obs-Gyn diagnosis and treatment.2003 • Williams Obstetrics .2005 • The Merck manual of diagnosis and therapy.1999