prelabor rupture of membranes and preterm prelabor rupture of membranes

Question 1

A 37 yo G3 P1011 at 31 weeks EGA presents to Labor and Delivery stating that she has been leaking a clear, odorless liquid from the vagina for two hours.
On exam, you note a large amount of clear fluid in the vagina.

Answer 1

Vaginal pH is 5.5. There is ferning noted on microscopy. You send a Group B strep culture. You administer betamethasone to the patient and begin magnesium sulfate 4 gm IV followed by 1 gm/hr via IV infusion.

Question 2

prelabor rupture of membranes (PROM)

Answer 2

-Rupture of membranes (“breaking the water”) prior to onset of labor at term
-Occurs in about 8% of parturients
-if infected -> dont contract as well

-Etiology
-At term, due to weakening of the amnion and due to the force of contractions
-Sequelae:
-Intrauterine infection
-Fetal tachycardia
-Fetal hypoxemia, acidosis
-Maternal chorioamnionitis
-Possible need for Caesarean section

Question 3

dx of prelabor rupture of membranes

Answer 3

-Based on sterile speculum exam
-Pooling of amniotic fluid in vaginal vault
-Vaginal pH >4.5
-Arborization of dried amniotic fluid via microscopy

-have the pt cough -> and if you see the fluid come out the cervix -> amniotic fluid
-baby is still peeing even after rupture

Question 4

Answer 4

Arborization of amniotic fluid (ferning)

Question 5

management of prelabor rupture of membranes

Answer 5

-From 34 weeks on:
-Deliver
-Obtain Group B strep culture
-If positive, treat with penicillin G 5 million units IV x 1 dose; then 2.5 million units IV Q4H until delivery

Question 6

preterm prelabor rupture of membranes (PPROM)

Answer 6

-Etiology
-Before term, often due to evident intrauterine infection (in up to about 35% of patients)

-Occurs between 20-36 weeks, 6 days
-When intrauterine infection is present, the sequelae are the same as PROM
-Also those of prematurity, if the patient is delivered preterm
-50% of patients will deliver within 7 days of ROM

Question 7

sequelae of preterm prelabor rupture of membranes (PPROM)

Answer 7

-NEONATAL:
-Sequelae of prematurity
-Respiratory distress is most common
-Necrotizing enterocolitis
-Sepsis
-Interventricular hemorrhage

-MATERNAL:
-Chorioamnionitis
-Abruptio placentae
-Postpartum endometritis
-Retained placenta
-Sepsis

Question 8

management of preterm prelabor rupture of membranes

Answer 8

-preterm (24-33 weeks, 6 days):
-Admission
-Expectant management
-Latency antibiotics (ampicillin, amoxicillin, and erythromycin) if no contraindications exist
-Single dose of betamethasone or dexamethasone
-Magnesium sulfate for neuroprotection, if <32 weeks GA
-Send Group B strep culture and treat if positive as noted above

Question 9

management of PREVIABLE, prelabor rupture of membranes

Answer 9

-< 24 wks:
-Admission
-Patient counseling
-Expectant management or induction of labor
-Antibiotics
-Neonatology consultation

-if considered to be nonviable, do NOT offer:
-Steroids
-Magnesium sulfate
-Group B strep prophylaxis
-Tocolysis

Question 10

which of the following is indicated in a pt with preterm prelabor rupture of membranes at 31 weeks gestational age

Answer 10

-oxytocin
-nifedipine
-consultation with neonatologist
-magnesium sulfate!!!!!!!!!