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Obstetrics > Preterm Rupture of Membranes > Flashcards

Preterm Rupture of Membranes Flashcards

1
Q

What does pre-labour rupture of membranes mean?

A

It means the rupture of membranes after 37 weeks but without contractions starting within 1 hour

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2
Q

What does preterm rupture of membranes mean?

A

It means the rupture of membranes before 37 weeks without uterine contractions

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3
Q

What are the consequences of preterm rupture of membranes(especially before 34 weeks?)

A

Preterm rupture of membranes causes hyaline membrane disease and other complications of prematurity

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4
Q

What is the complication that often follows maternally after PROM?

A

-bacterial infection which can lead to septicaemia and septic shock

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5
Q

What is the complication that often follows foetally after PROM?

A

The neonate may experience infection like pneumonia

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6
Q

What is the most common cause of preterm labour and pre-term rupture of membranes?

A
  1. Infection of the membranes and placenta
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7
Q

What are the fetal causes of pre-term rupture of membranes?

A
  1. Chorioamnionitis
  2. Multiple pregnancies
  3. Polyhydroamnios
  4. Congenital fetal abnormalities like neural tube defects and gastro-intestinal defects
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8
Q

What are the placental factors that cause pre-term rupture of membranes?

A

Placenta praevia

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9
Q

What are the risk factors that can lead to pre-term rupture of membranes?

A
  1. Previous PROM
  2. No antenatal care
  3. Poor socio-economic circumstances
  4. Smoking and alcohol abuse
  5. Sex in the second half of pregnancy because of high risk of STI transmission
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10
Q

What is important about the history in patients with PROM?

A

-They usually present with a gush in large volume of fluid and then have a continuous small vaginal discharge

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11
Q

What is the definitive diagnosis for PROM?

A
  1. Pooling or when speculum examination is being done there is visible drainage of fluid that confirms the diagnosis
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12
Q

What can we do if we cannot confirm the diagnosis for PROM and no fluid pools?

A

We can do a posterior fornix wet smear test to test for pH and a fern leaf test on a glass side

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13
Q

How can we differentiate between a copious vaginal discharge and amniotic fluid?

A
  1. Two separate wet mounts with normal saline and 3% potassium hydroxide must be prepared for microscopic examination
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14
Q

If we do confirm that there is PROM , what is the next step that will help in our management?

A
  1. Do an endocervical swab to culture for group B streptococcus
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15
Q

How should we collect the fluid from the vagina?

A
  1. With a syringe

2. If not enough fluid then use a swab at the posterior fornix

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16
Q

Is vaginal secretion acidic or alkaline?

A

It is acidic <7

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17
Q

Is amniotic fluid acidic or alkaline?

A

Amniotic fluid is alkaline >7

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18
Q

What does it mean if red litmus paper turns blue?

A

It means that it has come into contact with amniotic fluid and it is alkaline

19
Q

What can we do to test the vaginal pH?

A

We can use red litmus paper

20
Q

What is the fern pattern test?

A

It is a test where vaginal fluid is taken with a wooden spoon and smeared on a glass slide and examined microscopically

21
Q

What are the side room investigations we can do to detect PROM?

A
  1. Red litmus paper test

2. Fern pattern test

22
Q

What is the management of PROM?

A

There are two options:

  1. Induction of labour for the fetus is viable-give antibiotics to prevent chorioamnionitis symptoms
  2. Continue pregnancy if <34 weeks
23
Q

How many women end up going into labour 24 hours after PROM?

A

50% of women

24
Q

How many women end up going into labour at least a week after PROM?

A

90% of women

25
Q

What increases the risk of chorioamnionitis in a patient?

A
  1. HIV
  2. Post-coitus
  3. Vaginal examination after PROM
  4. No antenatal care
26
Q

What do we do if the patient is already in labour?

A

We allow the patient to deliver

27
Q

What do we if the patient is in labour but has a premature foetus?

A

We give betamethasone to at least allow lung maturity in the next 24 hours

28
Q

In which cases would we do a c/s in patient?

A
  1. Foetal distress
  2. Chorioamnionitis -give AB
  3. Congenital fetal abnormalities
29
Q

What do we do if the patient is >34 weeks?

A

Induction of labour

30
Q

What do we do if the patient is <34 weeks?

A
  1. Truly confirm gestation with ultrasound (fetal weight being less than 2000g) or if the SF height is <30 cm
31
Q

What should we do if we have a patient that is less than 26 weeks and experiences PROM?

A

We need to induce labour because the prognosis for these babies is very poor

32
Q

What is a contra-indication fro post-posing labour?

A

Chorioamnionitis

33
Q

How can we ensure better prognosis for babies?

A
  1. Administer corticosteroids for lung maturity especially between 28-32 weeks
    This must be done for a period of 24 hours before labour
34
Q

When can we send the patient home ?

A
  1. If the discharge disappears for at least 2 days and ultrasound confirms increase in amniotic fluid
  2. The patient can come tho high risk clinic weekly for follow up
35
Q

When should the mother be re-admitted if they present again?

A
  1. If there is a vaginal discharge with an offensive smell
  2. She feels feverish and unwell
  3. If she recently sat in a bath or had sex
36
Q

What are the indications for us inducing labour in patients with PROM?

A
  1. Clinical signs of chorioamnionitis
  2. If the patients is <26 weeks(foetus is not viable)
  3. If the patient is >34 weeks(baby is viable)
  4. Foetal distress
  5. Cord prolapse
  6. Antepartum haemorrhage
  7. Intra-uterine death or severe congenital abnormalities
  8. Intra-uterine growth restriction
37
Q

What two methods can be used to induce labour in patients with PROM?

A
  1. Oxytocin

2. Oral misoprotil (cytotec) 50 mcg 6 hourly with fetal heart monitoring

38
Q

Why should we not use OxyContin and misoprostol together?

A

It can cause excessive contractions and thus lead to foetal distress

39
Q

What should you tell women who present with PROM in regards to their next pregnancy?

A
  1. They should start antenatal care as early a possible
  2. Using condoms in the 2nd trimester helps prevent chorioamnionitis
  3. Midstream urine with help screen for bacteria
40
Q

What is the management of PROM (pre-labour rupture) in district 1 hospitals?

A

In pre-labour rupture patients if it not associated with an infection it is not an emergency and we can wait 24 hours for the cervix to become more ready
-induction is usually initiated early morning (around 8am)

41
Q

How many patients will go into spontaneous labour after pre-labour induction of labour?

A

80% of them

42
Q

What is the management of PROM in district 2 hospitals? These being regional and tertiary hospitals

A

-patients are induced immediately and OxyContin or misoprostol is started

43
Q

When do we start foetal heart monitoring in these babies?

A

At 28 weeks

Obstetrics (18 decks)

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