PROM/PPROM
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| What is PROM | Spontaneous disruption of fetal membrane integrity prior to onset of labor
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| What is PPROM | Disruption of fetal membrane integrity before completion of 37 weeks gestation
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| What is prolonged PROM? | When more than 24 hours elapses between rupture of the membranes and onset of labor.
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| What is the etiology of PROM? | -vaginal/cervical infections
-abnormal membrane physiology
-incompetent cervix
-nutritional deficiencies
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| How is PROM diagnosed? | -History? vaginal loss of fluid
-Confirm amniotic fluid in vagina
RULEOUT: urine incont/leukorhea/mucous plug
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| On what does the management of PROM depend? | On Gestational Age
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| 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
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| Confirmation of PROM/PPROM? | Fluid pool in posterior fornix
-nitrazine paper turns blue (pH>6)
blood/mucus/urine/sperm false +
-ferning on slide
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| Why is U/S done? | to rule out fetal anomalies
to assess gestational age
to assess amniotic fluid volume
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| Oligohydramnios associated with PROM in fetus <24 weeks, may develop? | Pulmonary hypoplasia
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| At what GA is labor induction ideal management in a woman with PROM | at 34+ weeks, induce labor 6-12 hours post rupture
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| PPROM managment? | -prolonging gestation until lung profile is mature
-risk of prematurity>infection
RDS/IVH/NEC
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| Chorioamnionitis? | -high maternal temp >38
-tender, irritable uterus on non-stress test
-tachycardia fetal/maternal
CONFIRM: amniocentesis culture+ve
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| PPROM what prolongs latent phase? | Ampicillin or erythromycin
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| Chorioamnionitis management? | ABX therapy>> ampicillin and gentamyicn. with INDUCTION of labor
unfavorable >> C/S
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| Tocolytics in PROM yes or no? why? | controversial, may mask evidence of maternal infection
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| Corticosteroids in PROM? | PPROM? upto 32 weeks
PROM? no need.
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| Lung profile? | Chromatography:
PG and PI
L/S ratio 2/1
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