PPROM

Question 1

Dx

Answer 1

H/O gush of fluid/continual leakage
Exam - sterile spec: wait 30 mins - pooling of fluid
- nitrazine paper turns blue with increased pH
- ferning pattern seen on light microscopy
- decreased AFV on USD scan

Question 2

Mx

Answer 2

• GBS low vaginal swab
• antibiotics:
  not in labour - erythromycin PO
  in labour/imminent - benzylpenicillin 1.2mg loading dose. 600mg Q6hrs
• steroids (24-34wks) : betamethasone 11.4mg now then at 24hrs.
• tocolysis; nifedipine 20mg every 30mins. max of 160mg/day until contractions stop. Maintenance of 20mg Q6Hrs max of 48hrs.