PREMATURE RUPTURE OF FETAL MEMBRANE Flashcards
two main classifications of premature membrane rupture:
•TERM Premature rupture of membranes (PROM) – the rupture of fetal membranes prior to the onset of labour, at ≥37 weeks gestation.
•It occurs in 10-15% of term pregnancies, and is associated with minimal risk to the mother and fetus due to the advanced gestation.
•Pre-term premature rupture of membranes (P-PROM) – the rupture of fetal membranes occurring at <37 weeks gestation.
•It complicates ~2% of pregnancies and has higher rates of maternal and fetal complications. It is associated with 40% of preterm deliveries.
causes
There appears to be no single etiology of preterm PROM.
•Choriodecidual infection or inflammation
•A decrease in the collagen content of the membranes
•Low socioeconomic conditions
•Sexually transmitted infections, such as chlamydia and gonorrheasuch as Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), candidiasis, syphilis, bacterial vaginosis, Neisseria gonorrhoea and Group B Streptococcus.
•Previous preterm birth.
•Vaginal bleeding.
•Idiopathic
•Polyhydramnios
•work during pregnancy, low Body Mass Index(poor nutrition)
•antepartum hemorrhage
Risk factors
Black patients are at increased risk of preterm PROM compared with white patients.
•Other patients at higher risk include those who have lower socioeconomic status, are smokers, have a history of sexually transmitted infections, have had a previous preterm delivery, have vaginal bleeding, or have uterine distension (e.g., polyhydramnios, multifetal pregnancy).
•Procedures that may result in preterm PROM include cerclage and amniocentesis.
•Others includes increased physiologic secretions of pregnancy, pathologic discharge associated with vaginitis or cervicitis, urinary incontinence that may be associated with lower urinary tract infection, vesicovaginal or rectovaginal fistula in women with a history of previous delivery,
Definition of PROM
Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM). PROM occurs in about 8 to 10 percent of all pregnancies
complications of PROM
It can lead to significant perinatal morbidity, including Respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death.
•Delivery within one week
•Cord compression
•Chorioamnionitis
•Antepartum fetal death
Diagnosis
speculum examination to evaluate if any cervical dilation
• avoid performing a digital cervical examination
•using nitrazine paper4.5 and 6.0
•Nitrazine paper will turn blue when the pH is above 6.0; however, the presence of contaminating substances (e.g., blood, semen, alkaline antiseptics) also can cause nitrazine paper to turn blue, giving a false-positive result.
•Ultrasonography it may help determine the position of the fetus, placental location, estimated fetal weight, and presence of any anomalies.
Positive fern test; visualization of fern like pattern of dried amniotic fluid on a glass slide under a microscope (due to NaCl crystals)
Treatment
Antibiotics should be administered to patients with preterm PROM because they prolong the latent period and improve outcomes.
•Corticosteroids should be given to patients with preterm PROM between 24 and 32 weeks’ gestation to decrease the risk of intraventricular hemorrhage, respiratory distress syndrome, and necrotizing enterocolitis.
•Physicians should not perform digital cervical examinations on patients with preterm PROM because they decrease the latent period. Speculum examination is preferred.
•Long-term tocolysis is not indicated for patients with preterm PROM, although short-term tocolysis may be considered to facilitate maternal transport and the administration of corticosteroids and antibiotics.
Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks’ gestation are not recommended.
•Interestingly, in some pregnancies complicated by preterm premature rupture of membranes (pPROM), membranes heal spontaneously and pregnancy continues until term.
Treatment
Antibiotics should be administered to patients with preterm PROM because they prolong the latent period and improve outcomes.
•Corticosteroids should be given to patients with preterm PROM between 24 and 32 weeks’ gestation to decrease the risk of intraventricular hemorrhage, respiratory distress syndrome, and necrotizing enterocolitis.
•Physicians should not perform digital cervical examinations on patients with preterm PROM because they decrease the latent period. Speculum examination is preferred.
•Long-term tocolysis is not indicated for patients with preterm PROM, although short-term tocolysis may be considered to facilitate maternal transport and the administration of corticosteroids and antibiotics.
•Multiple courses of corticosteroids and the use of corticosteroids after 34 weeks’ gestation are not recommended.
•Interestingly, in some pregnancies complicated by preterm premature rupture of membranes (pPROM), membranes heal spontaneously and pregnancy continues until term.
• Treatment varies depending on gestational age and includes consideration of delivery when rupture of membranes occurs at or after 34 weeks’ gestation. Corticosteroids can reduce many neonatal complications, particularly intraventricular hemorrhage and respiratory distress syndrome, and antibiotics are effective for increasing the latency period.
Treatment;
most widely used and recommended steroid regimens include
intramuscular betamethasone (Celestone) 12 mg every 24 hours for two days,
