Preterm Rupture of Membranes Flashcards
What does pre-labour rupture of membranes mean?
It means the rupture of membranes after 37 weeks but without contractions starting within 1 hour
What does preterm rupture of membranes mean?
It means the rupture of membranes before 37 weeks without uterine contractions
What are the consequences of preterm rupture of membranes(especially before 34 weeks?)
Preterm rupture of membranes causes hyaline membrane disease and other complications of prematurity
What is the complication that often follows maternally after PROM?
-bacterial infection which can lead to septicaemia and septic shock
What is the complication that often follows foetally after PROM?
The neonate may experience infection like pneumonia
What is the most common cause of preterm labour and pre-term rupture of membranes?
- Infection of the membranes and placenta
What are the fetal causes of pre-term rupture of membranes?
- Chorioamnionitis
- Multiple pregnancies
- Polyhydroamnios
- Congenital fetal abnormalities like neural tube defects and gastro-intestinal defects
What are the placental factors that cause pre-term rupture of membranes?
Placenta praevia
What are the risk factors that can lead to pre-term rupture of membranes?
- Previous PROM
- No antenatal care
- Poor socio-economic circumstances
- Smoking and alcohol abuse
- Sex in the second half of pregnancy because of high risk of STI transmission
What is important about the history in patients with PROM?
-They usually present with a gush in large volume of fluid and then have a continuous small vaginal discharge
What is the definitive diagnosis for PROM?
- Pooling or when speculum examination is being done there is visible drainage of fluid that confirms the diagnosis
What can we do if we cannot confirm the diagnosis for PROM and no fluid pools?
We can do a posterior fornix wet smear test to test for pH and a fern leaf test on a glass side
How can we differentiate between a copious vaginal discharge and amniotic fluid?
- Two separate wet mounts with normal saline and 3% potassium hydroxide must be prepared for microscopic examination
If we do confirm that there is PROM , what is the next step that will help in our management?
- Do an endocervical swab to culture for group B streptococcus
How should we collect the fluid from the vagina?
- With a syringe
2. If not enough fluid then use a swab at the posterior fornix
Is vaginal secretion acidic or alkaline?
It is acidic <7
Is amniotic fluid acidic or alkaline?
Amniotic fluid is alkaline >7
What does it mean if red litmus paper turns blue?
It means that it has come into contact with amniotic fluid and it is alkaline
What can we do to test the vaginal pH?
We can use red litmus paper
What is the fern pattern test?
It is a test where vaginal fluid is taken with a wooden spoon and smeared on a glass slide and examined microscopically
What are the side room investigations we can do to detect PROM?
- Red litmus paper test
2. Fern pattern test
What is the management of PROM?
There are two options:
- Induction of labour for the fetus is viable-give antibiotics to prevent chorioamnionitis symptoms
- Continue pregnancy if <34 weeks
How many women end up going into labour 24 hours after PROM?
50% of women
How many women end up going into labour at least a week after PROM?
90% of women
What increases the risk of chorioamnionitis in a patient?
- HIV
- Post-coitus
- Vaginal examination after PROM
- No antenatal care
What do we do if the patient is already in labour?
We allow the patient to deliver
What do we if the patient is in labour but has a premature foetus?
We give betamethasone to at least allow lung maturity in the next 24 hours
In which cases would we do a c/s in patient?
- Foetal distress
- Chorioamnionitis -give AB
- Congenital fetal abnormalities
What do we do if the patient is >34 weeks?
Induction of labour
What do we do if the patient is <34 weeks?
- Truly confirm gestation with ultrasound (fetal weight being less than 2000g) or if the SF height is <30 cm
What should we do if we have a patient that is less than 26 weeks and experiences PROM?
We need to induce labour because the prognosis for these babies is very poor
What is a contra-indication fro post-posing labour?
Chorioamnionitis
How can we ensure better prognosis for babies?
- Administer corticosteroids for lung maturity especially between 28-32 weeks
This must be done for a period of 24 hours before labour
When can we send the patient home ?
- If the discharge disappears for at least 2 days and ultrasound confirms increase in amniotic fluid
- The patient can come tho high risk clinic weekly for follow up
When should the mother be re-admitted if they present again?
- If there is a vaginal discharge with an offensive smell
- She feels feverish and unwell
- If she recently sat in a bath or had sex
What are the indications for us inducing labour in patients with PROM?
- Clinical signs of chorioamnionitis
- If the patients is <26 weeks(foetus is not viable)
- If the patient is >34 weeks(baby is viable)
- Foetal distress
- Cord prolapse
- Antepartum haemorrhage
- Intra-uterine death or severe congenital abnormalities
- Intra-uterine growth restriction
What two methods can be used to induce labour in patients with PROM?
- Oxytocin
2. Oral misoprotil (cytotec) 50 mcg 6 hourly with fetal heart monitoring
Why should we not use OxyContin and misoprostol together?
It can cause excessive contractions and thus lead to foetal distress
What should you tell women who present with PROM in regards to their next pregnancy?
- They should start antenatal care as early a possible
- Using condoms in the 2nd trimester helps prevent chorioamnionitis
- Midstream urine with help screen for bacteria
What is the management of PROM (pre-labour rupture) in district 1 hospitals?
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)
How many patients will go into spontaneous labour after pre-labour induction of labour?
80% of them
What is the management of PROM in district 2 hospitals? These being regional and tertiary hospitals
-patients are induced immediately and OxyContin or misoprostol is started
When do we start foetal heart monitoring in these babies?
At 28 weeks
