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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
Created by: asabi3