PROM

Question 1

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods. Discuss your approach to this patient

Answer 1

History
Examination
Confirm ROM
ROM management
DVT management
Advice for future

Question 2

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

History

Answer 2

Planned, wanted, booked
BF
Contraception
Main complaint
Rest of history

Question 3

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

Examination

Answer 3

Weight, height, MUAC
General
Systems

Question 4

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

How to confirm ROM

Answer 4

Fluid from the os
Cough 
Litmus
Ferning
Nitrazine
Amnisure pads

Question 5

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

ROM management

Answer 5

1. Admit
2. Corticosteroids
3. Antibiotics
4. Tocolyse
5. Amnioinfusion
6. U-MCS
7. Expectant management
   - inpatient
   - no PV
   - monitor for IUI
8. Deliver if IUI, labour or 34w GA

Question 6

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

DVT management

Answer 6

History
Examination
Duplex dopper
Start with heparin and continue with warfarin for 6mo

Question 7

Mrs SM 28yo P0M1G2 at 30w GA to labour ward with LAP starting 4hrs ago and a gush of fluid via vagina. Booked with normal bloods.

Advice for future

Answer 7

Continue warfarin 
Effective contraception
No oestrogen 
Weight loss
Smoking cessation
Anticoagulation next pregnancy