Obs - PPROM + PROM

Question 1

A woman presents to MAU at 31+6/40 in spontaneous labour. Membranes have ruptured and she is 4cm dilated. Tocolysis is not being considered.

Name 3 medications she should be given and explain why.

Answer 1

1. DEXAMETHASONE IM 12g x2 12hrs apart (most effective at 24hrs-7days): reduces risk of RDS by enabling release of foetal lung surfactant
2. MAGENSIUM SULFATE: neuroprotective by reducing risk of intraventricular + periventricular haemorrhage
3. BENZYLPENICILLIN 3g stat IV followed by 1.5g IV 4 hourly

Question 2

When would you consider tocolysis in the context of preterm delivery? Name 2 drugs you could use.

Answer 2

Only consider up to 32/40 (or up to 34/40 where in utero transfer is required). Dilation >3cm, vaginal bleeding and ruptured membranes are relative contraindications.

1. NIFEDIPINE (do not use simultaneously with magnesium sulfate): CCB that inhibits uterine activity. Can cause palpitations, flushing, hypotension.
2. ATOSIBAN: oxytocin receptor antagonist.

Question 3

Suggest risk factors for preterm birth.

Answer 3

1. previous preterm delivery
2. poor social conditions (poverty)
3. smoking
4. maternal age <20 or >35
5. APH
6. overdistension of uterus e.g. multiple pregnancy or polyhydramnios
7. uterine anomalies or cervical incompetence
8. genital tract infection e.g. chorioamnionitis: GBS, gonorrhoea, mycoplasma, gardnerella
9. severe maternal illness

Question 4

A G1PO presents to MAU at 33/40 due to leakage of clear vaginal fluid. There are no contractions.
How would you assess this woman?

Answer 4

1. Sterile speculum examination: fluid draining from cervix/pooling in posterior vaginal fornix
2. if unclear Dx consider: USS or swab for IGFBP-1
3. assess for chorioamnionitis:
   - clinical assessment
   - CRP + FBC
   - FHR

Question 5

A G1PO presents to MAU at 33/40 due to leakage of clear vaginal fluid and this is confirmed on speculum examination. There are no contractions and no cervical dilaiton.
How should she be managed?

Answer 5

1. monitor for signs of clinical chorioamnionitis
2. prophylactic ERYTHROMYCIN 250mg QDS for 10/7
3. DEXAMETHASONE 12mg IM 2 doses 12hrs apart
4. expectant Mx