| Question | Answer |
| What is PROM | Spontaneous disruption of fetal membrane integrity prior to onset of labor |
| What is PPROM | Disruption of fetal membrane integrity before completion of 37 weeks gestation |
| What is prolonged PROM? | When more than 24 hours elapses between rupture of the membranes and onset of labor. |
| What is the etiology of PROM? | -vaginal/cervical infections
-abnormal membrane physiology
-incompetent cervix
-nutritional deficiencies |
| How is PROM diagnosed? | -History? vaginal loss of fluid
-Confirm amniotic fluid in vagina
RULEOUT: urine incont/leukorhea/mucous plug |
| On what does the management of PROM depend? | On Gestational Age |
| What should be used to examine the vagina of a pt with PROM/PPROM not in labor? | Sterile speculum. NEVER HAND.
confirm dx, assess cervical dilation,length.
if PPROM:fluidsample/cultures |
| Confirmation of PROM/PPROM? | Fluid pool in posterior fornix
-nitrazine paper turns blue (pH>6)
blood/mucus/urine/sperm false +
-ferning on slide |
| Why is U/S done? | to rule out fetal anomalies
to assess gestational age
to assess amniotic fluid volume |
| Oligohydramnios associated with PROM in fetus <24 weeks, may develop? | Pulmonary hypoplasia |
| At what GA is labor induction ideal management in a woman with PROM | at 34+ weeks, induce labor 6-12 hours post rupture |
| PPROM managment? | -prolonging gestation until lung profile is mature
-risk of prematurity>infection
RDS/IVH/NEC |
| Chorioamnionitis? | -high maternal temp >38
-tender, irritable uterus on non-stress test
-tachycardia fetal/maternal
CONFIRM: amniocentesis culture+ve |
| PPROM what prolongs latent phase? | Ampicillin or erythromycin |
| Chorioamnionitis management? | ABX therapy>> ampicillin and gentamyicn. with INDUCTION of labor
unfavorable >> C/S |
| Tocolytics in PROM yes or no? why? | controversial, may mask evidence of maternal infection |
| Corticosteroids in PROM? | PPROM? upto 32 weeks
PROM? no need. |
| Lung profile? | Chromatography:
PG and PI
L/S ratio 2/1 |
