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A - MSRA Obstetrics [16] > [23] Pre-term Prelabour Rupture Of Membranes > Flashcards

[23] Pre-term Prelabour Rupture Of Membranes Flashcards

1
Q

What is preterm pre-labour rupture of membranes (P-PROM)?

A

The rupture of membranes prior to the onset of labour in a patient who is less than 37 weeks gestation

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2
Q

In what % of pregnancies does P-PROM occur in?

A

2%

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3
Q

What % of pre-term deliveries are associated with P-PROM?

A

40%

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4
Q

What will happen to most women who rupture their membranes?

A

Most women will go into labour within 24 hours

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5
Q

What % of women will not go into labour within 96 hours of ruptured their membranes?

A

6%

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6
Q

What effect does the gestation at which membrane rupture occurs have on the likelihood of going into labour?

A

The earlier in gestation the rupture occurs, the less likely that the onset of labour will be within a specified time period

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7
Q

What are the risk factors for P-PROM?

A
  • Smoking
  • Previous preterm delivery
  • Vaginal bleeding at any time during pregnancy
  • Lower genital tract infection
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8
Q

How might P-PROM present?

A

Mother may give history of ‘popping sensation’ or ‘gush’, with continuous watery liquid draining after

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9
Q

Why should you not routinely perform vaginal examination in women with P-PROM?

A

As it will increase the risk of ascend infection

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10
Q

In what ways can the diagnosis of P-PROM be made?

A
  • Visually

- Testing for specific factors

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11
Q

How can the diagnosis of P-PROM be made visually?

A
  • Seeing amniotic fluid draining from cervix and pooling in vagina after woman has been lying down for 30 minutes
  • Regular pad checks
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12
Q

How can amniotic fluid be seen draining from the cervix?

A

Sterile speculum examination

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13
Q

What factors can be tested for to aid the diagnosis of P-PROM?

A
  • Insulin-like growth factor binding protein-1

- Placental alpha-microglobulin-1

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14
Q

What should be remembered when using testing for factors to aid the diagnosis of P-PROM?

A

Results should not be considered in isolation

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15
Q

What does amnioquick test for?

A

Insulin-like growth factor binding protein-1

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16
Q

What other investigations may be done in P-PROM?

A
  • Ultrasound
  • Temperature monitoring
  • Fetal monitoring
17
Q

Why might ultrasound be useful in P-PROM?

A

To check for gestation and liquor volume

18
Q

How often should temperature monitoring be done in P-PROM?

A

At least every 12 hours

19
Q

Why should temperature monitoring be done in P-PROM?

A

To check for ascending infection

20
Q

When should you immediately refer to hospital in P-PROM?

A

If P-PROM is suspected, or if ascending infection is suspected

21
Q

What can indicate ascending infection in pregnancy?

A
  • Maternal or fetal tachycardia
  • Pyrexia
  • Abdominal tenderness
22
Q

What does the management of P-PROM?

A

Antibiotic administration

23
Q

What is the role of prophylactic antibiotics in P-PROM?

A

They appear to reduce complications due to pre-term delivery and post-natal infection

24
Q

What antibiotic is given for prophylaxis in P-PROM?

A

Erythromycin

25
Q

When are antenatal steroids given in P-PROM?

A

If gestation is 24-34+6 weeks

26
Q

Are tocolytics recommended in P-PROM?

A

No

27
Q

When should delivery be considered in P-PROM?

A

At 34 weeks

28
Q

What should be done if the pregnancy continues over 36 weeks in P-PROM?

A

The mother should be informed that she is at increased risk of chorioamnioitis and a reduced risk of respiratory problems for the neonate

29
Q

What can be used to prevent P-PROM?

A

Intravaginal progesterone and cervical cerclage

30
Q

When should the need for prevention for P-PROM be considered?

A

When a woman has a cervical length of <25mm on transvaginal ultrasound between 16-34 weeks

31
Q

What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and a previous preterm birth or pregnancy loss between 16-34 weeks?

A

Offer either intravaginal progesterone

32
Q

What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and no history of pre-term birth or pregnancy loss between 16-34 weeks/

A

Offer IV progesterone

33
Q

What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and had P-PROM in previous pregnancy or history of cervical trauma?

A

Offer cervical cerclage

34
Q

What are the 3 main causes of neonatal mortality associated with P-PROM?

A
  • Prematurity
  • Sepsis
  • Pulmonary hypoplasia
35
Q

What are the other complications of P-PROM?

A
  • Umbilical cord prolapse
  • Placental abruption
  • Oligohydraminos
  • Increased incidence of retained placenta and secondary post-partum haemorrahge
36
Q

When can P-PROM cause oligohydraminos?

A

If it happens early in pregnancy

A - MSRA Obstetrics [16] (61 decks)

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