PROM and Preterm Labour Flashcards
Define PROM and PPROM.
Premature rupture of membranes (PROM) is defined as rupture of membranes occurring before the onset of labor
at term (≥ 37 weeks) or earlier (preterm PROM if < 37 weeks
Describe how the pathophysiology of PROM and PPROM comes about?
What are the risk factors of PROM/PPROM? And explain how they come to be?
Previous PROM or PPROM
Ascending infection (UTI)
Nutrition deficiencies
Smoking
Multiple gestation
Polyhydramnios
Incompetent cervix
Antepartum bleeding ( mostly 2nd and 3rd trimester)
Genetic predisposition
Describe the clinical presentation of someone presenting iwth PROM/PPROM.
A sudden ‘gush of fluid’ leaking from the vagina
Cramping
Recurrent dampness or constant leaking
No Contractions
Back pain
What are the imminent history taking points in someone with PROM?
Contractions
Fetal movement
Time of possiblerupture
Amount of fluid
Color and odor of fluid
Vaginal bleeding
Pain
Recent sexual encounters
Recent trauma and recent physical activity
What exam done in a patient with PROM/PRROM?
A sterile speculum exam
What investigations are done in PPROM?
Ultrasonography
Full blood count
Urinalysis, culture and sensitivity
Nitrazine test or PH indicator
Fern test
What is the normal vaginal pH and what is the pH of liqour?
Vagina: 4.5-5.5
Liqour: 7-7.75
What exam should be avoided and why?
Digital vaginal examination
Because it can introduce organisms into cervical canal, increases the incidence of chorioamnionitis, post-partum endometritis and neonatal infection.
What is seen in a sterile speculum exam in P/PROM?
To Visualize amniotic fluid passing from the cervical canal and pooling in the vagina.
To exclude any signs of cervicitis, umbilical cord prolapse, vaginal bleeding or fetal prolapse
To take cervical swab
Why is temperature, BPs and Pulse rate important?
To rule out chorioamnionitis characterised by maternal fever and tachycardia
Describe the management of P/PROM
REFER TO GUIDELINES
What are the fetal complications of PROM/PPROM?
Preterm
Placenta Abruption
Neonatal Sepsis
Cerebral Palsy
Infection
RDS
What are the maternal complications of P/PROM?
Infection
Risk of C/S
Thromboembolic events
What is Preterm Labour?
Preterm labor means derivery that occur early I.e. before 37 completed weeks of gestation.
What are the causes of preterm labour?
Ascending infection
UTI
Cervicitis
Bacterial vaginosis
Candida infection
Systemic infection
Febrile illness i.e malaria
Uterine distension
Multiple pregnancy
Macrosomia
Polyhydramnios
Placenta abruption
PPROM
Uterine malformations
Bicornuate uterus
Fibroid uterus
Cervical weakness
What are the risk factors of preterm labour?
Age < 18
Previous preterm birth
Previous still birth
High parity
Anemia
Low social economic status
Hypertension in pregnancy
Diabetes
Maternal stress
Persistent malaria
What is the clinical presentation of a patient in preterm labour?
Lower abdominal pain
Backache
Early contractions
What exam can be done in Preterm Labor and when can it be done?
Vaginal Exam to confirm cervical effacement and dilation but after placenta abruption and previa have been ruled out.
What investigations are done in Preterm labour?
Transvaginal ultrasound for short cervical length
Sterile Speculum exam
High vaginal swab
Urinalysis
MRDT
FBC
Describe the management of Preterm Labor?
REFER TO GUIDELINES.
