premature rupture of the membrane

Question 1

what the meaning of premature rupture of the membrane ?

Answer 1

its the rupture of the membrane before the onset of deliver before 37 week
but if rupture is before 24 week its abortion
after 24 week its rupture membrane

Question 2

incedance of the rupture membrane ?

Answer 2

its 1-2%

Question 3

whats the complication of premature rupture of the membrane ?

Answer 3

its preterm labor for 1/3 of them
so majority of then will deliver within 1 week

1- chorioaminitis 
2-abruption placentae 
3-cord prolapse 
4-hyaline membrane disease (A respiratory disease of the newborn in which a membrane composed of proteins and dead cells lines the alveoli making gas exchange difficult or impossible)
5-pulmanary hypoplasia 
6- fetal distress 
7- fetal deformity

Question 4

whatre the cause of the premature rupture of the membrane ?

Answer 4

1- most common is accending gental infection
2- twins
3- polyhydramince
4-cervical incompetence (Cervical weakness)
5- multiple uterine fibroid
6- congintal anomlies

Question 5

what the clincal feature of premature rupture of the membrane ?

Answer 5

sudden gush of fluid spoutanous or after activity in any color

Question 6

how to dignosis the premature rupture of the membrane ?

Answer 6

1- by the speculum and ask the pt cough to see the Amniotic fluid in the vagina

2- use the nitrazine test to differnate wither it a liqor or exess moucous if
liqor is alkiline 7-7.5 change into blue
is vaginal secretion it acid 4.5-5.5

3-fern test by take sample from the fluid if it cervical moucus it will have fern like pattern under microscope

4-u/s to see the fluid which is the oligohydraminous

5- evaporation test 
6-intraamniotic fluorescein 
7- aminoscopy (infection) to see if there is chorioamintis 
8- fetal fibronectin 
9- alpha feto protein test

Question 7

whats the choriaminitis ? whatre the features and lab test ?

Answer 7

is one of the most risky complication of the premature rupture of the membrane its about 4.2-10.5%

systemic signs of infection
as fever , tachycardia maternal and fetal , abdominal tenderness , and vaginal foul smell

1- WBC count (high)
2- C -reactive protein
3- send gram stain of the amonitic fluid
4- leucoyte estrase assay (Leukocyte esterase is a screening test used to detect a substance that suggests there are white blood cells in the urine.)

Question 8

why there is placental abruption in case of premature rupture of the membrane ?

Answer 8

when there is polyhydraminous there will be sudden rupture of the membrane so there will be pressure disturbance so placenta will seprated

Question 9

hyaline membrane disease cause in the premature rupture of the membrane ?

Answer 9

normally the lung filled by fluid but when the membrane rupture there will be collapse in the lung

Question 10

what the cause of the fetal distress in the case of premature rupture of the membrane ?

Answer 10

1- chorioamnintis
2-cord prolapse
3- pressure on the cord by the presenting part

Question 11

when we deliver the fetus if the mother have premature rupture of the membrane ?

Answer 11

1- if the mother in full term means mother in labor 
2- mother with overt infection 
3- mother with fetal mature lung 
3- mother with fetal malformation 
4-mother with fetal distress 

اذا الام هي جاي تجيب مكمله الحمل
او ام الانفكش مالتها قوي
او اما. طفلها الرئه كطامله
او الطفل ما يتحمل في حاله خلل خلقي او التعب

Question 12

what re the mangment ?

Answer 12

1- deliver the baby in some cases

2- expectant mangament

Question 13

what re the expectatent mangmanet ?

Answer 13

1- bed rest
2- daily fallow up by temp , pulse , utrine contrcation , vaginal discharge
3- corticosteroid in the 12 -48 h give 8mg
4- antibiotic
5- tocolytic
6- termination of the prenenacy in case of the infection