PROM + P-PROM Flashcards
define premature labour
labour & delivery <37 weeks
what is the threshold of viability?
24 weeks
prophylaxis of preterm labour?
- progesterone
- given to woman w cervical length <25mm on US
- cervical cerclage
- stitch put into cervix to support it and keep it closed
Mx of preterm labour w intact membranes?
- tocolysis
- Nifedipine
- Atosiban
- corticosteroids
- mag sulphate
what does tocolysis do?
stops uterine contractions
what is P-PROM?
pre-term, pre-labour rupture of membranes
amniotic sac ruptures <37 weeks
diagnosis of P-PROM?
diagnosis= history + sterile speculum examination
- fluid pooling in posterior fornix of vagina
if still not clear–> vaginal fluid test for IGFBP/Alpha microglobulin-1
how can P-PROM present?
fluid gushing or continuous leak
Mx of P-PROM?
- Prophylactic Abx
- erythromycin
- corticosteroids if <36 weeks & risk of imminent delivery
- magnesium sulphate
- monitor mother & foetus in hospital for 2-3 days
- regular scans as risk of oligohyramnios
how do you give steroids?
2 doses, 24h apart
what is the purpose of magnesium sulphate?
neuro protection- reduces risk of cerebral palsy
What is PROM?
pre-labour rupture of membranes at term
diagnosis of PROM?
- history + sterile speculum examination
- to assess cervical dilatation
- TVUS
- if cervical length <15mm= diagnostic
- fetal fibronectin
- found in vagina
- if -ve: 99% of women won’t go into labour in 2 weeks
- if +ve: 1/10 women will go into labour
at what gestation can you test for FF?
22-34weeks
what other Ix would you do in PROM?
- bloods & urine dip
- CTG
Mx of PROM?
expectant vs immediate delivery (either spontaneous or IoL)
C/I to tocolysis?
- spontanous rupture of membranes
- IUGR
- Chorioamnionitis
RF’s of premature birth?
- ascending infection
- smoking
- short cervix
- previous PROM/PPROM
some complications of prematurity?
- retinopathy of prematurity
- necrotising enterocolitis
- intrventricular haemorrhage
- sepsis
