(p)PROM/PTB Flashcards
Risk factors
Maternal risks
Fetal risks
RF: Previous PTB, IUGR, PET, short cervix, cervical incompetence, multiples, infections, uterine anomalies
Mat risks: infection, sepsis, c-section, PPH
Fetal risks: prematurity, infection (GBS), LBW, RDS, IVH, NICU admission, high lactates
Ddx
Vaginal infections
UTI
Urinary incontinence
Management
Admit
Exam -> amnisure
IVL + Bloods (GH, CBC, CRP, UE, LFTS, MSU)
Steroids
Nifedipine - controversial
MgSO4
Oral abx or IV abx
Call paeds, anaesthetics and SMO
Scan for presentation
Consider OP with 2 x weekly check ins and weekly bloods
IOL at 37 weeks
Term PROM counselling
Same Ddx
Same investigations
Mat Risks: infection, PPH
Fetal risks: infection, high lactates, NICU admission, low apgars, mec aspiration, SB, HIE
Indications for immediate IOL rather than waiting as majority of women will labour within 24hours
- Infection, abnormal CTG, Mec, GBS
Explain to mother
- No increased risk of CS or instrumental because of the IOL
- Pain relief options are available
- Reduces risk to the baby
Cervical incompetence
Risks: PTB, uterine anomalies, multiples, previous cervical surgeries
Diagnosis on cervical length or examination
Symptoms: abdominal pain, contractions, abnormal DC, pressure
Risks to mother and baby
- CS, prematurity, 2nd trimester loss, retained tissue, MMH
Management
- Baseline MSU, HVS
- Cervical length screen at anatomy and high risk people 16-24 weeks
- Progesterone - previous misc and PV bleeding
- Shortened cervix <25mm then start progesterone, recheck and suture if required
- If <1cm then consider cerclage
- If history of cervical incompetence consider elective cerclage at 13-14 weeks
PPROM previable
Counsel parents on risks: lung hypoplasia, limb contractures, infection mat and fetal, long term morbidity and disability, low chance of survival intact
Referral to paeds
Consider steroids at 22+5 and tx
