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Obs&Gynae > PROM, PPROM, Preterm labour > Flashcards

PROM, PPROM, Preterm labour Flashcards

1
Q

What is Prelabor Rupture of Membranes (PROM)?

A

Rupture of membranes occurring before the onset of labor.

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2
Q

Define Preterm Prelabor Rupture of Membranes (PPROM).

A

Rupture of membranes before the onset of labor and before 37 weeks of gestation.

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3
Q

What are the key processes involved in the pathophysiology of PROM and PPROM? (3)

A
  1. Weakening of membranes due to collagen degradation by matrix metalloproteinases (MMPS) which are activated by pro inflammatory cytokines (from infection/ inflammation)
  2. Increased apoptotic markers leading to early weakening.
  3. Role of local cytokines in membrane weakening, by releasing prostaglandins
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4
Q

List the risk factors for PROM and PPROM. (7)

A
  1. Previous PROM or PPROM
  2. Ascending infection (e.g., UTI)
  3. Smoking
  4. Multiple gestation
  5. Polyhydramnios
  6. Incompetent cervix
  7. Antepartum bleeding
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5
Q

Describe the clinical presentation of PROM and PPROM. (2)

A
  1. A sudden ‘gush of fluid’ leaking from the vagina.
  2. Recurrent dampness or constant leaking.
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6
Q

What history should be taken for a patient suspected of PROM or PPROM? (8)

A
  1. Contractions
  2. Fetal movement
  3. Time of possible rupture
  4. Amount, color, and odor of fluid
  5. Vaginal bleeding
  6. Pain
  7. Recent sexual encounters
  8. Recent trauma and physical activity
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7
Q

What is the purpose of a sterile speculum examination in PROM or PPROM? (4)

A
  1. To visualize amniotic fluid passing from the cervical canal and pooling in the vagina.
  2. To exclude signs of cervicitis, umbilical cord prolapse, vaginal bleeding, or fetal prolapse.
  3. To take cervical swabs.
  4. To perform Nitrazine and Fern tests.
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8
Q

What investigations are important in diagnosing PROM and PPROM?
(5)

A
  1. Ultrasonography ( trans abdominal)
  2. Full blood count (FBC)
  3. Urinalysis culture and sensitivity
  4. Nitrazine test
  5. Fern test
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9
Q

What are the management strategies for PROM? (4)

A
  1. Start Benzyl Penicillin 2 MU q6h IV if PROM ≥ 18 hours.
  2. FBC, group & save.
  3. Induce/augment labor by 24 hours after PROM if term.
  4. Caesarean delivery if there is a previous cesarean section
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10
Q

How is PPROM managed at ≥ 34 weeks? (3)

A
  1. If HIV negative, induce or augment if no spontaneous labor within 24 hours of rupture.
  2. If HIV positive, start immediate induction if not in labor within 24 hours or consider cesarean.
  3. Deliver by cesarean section if there is a previous cesarean section.
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11
Q

What are the complications associated with PROM and PPROM? (8)

A
  1. Preterm labor
  2. Placenta abruption
  3. Neonatal sepsis
  4. Cord prolapse
  5. Malpresentation
  6. Infection
  7. Fetal pulmonary hypoplasia
  8. Increased perinatal morbidities
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12
Q

How is chorioamnionitis managed in the context of PROM or PPROM? (2)

A
  1. Ampicillin 1 g OR Benzyl Penicillin 2 MU IV q6h plus Gentamicin 240 mg daily IV until 48 hours afebrile.
  2. If still spiking fevers, add Metronidazole 500 mg IV every 8 hours until 48 hours afebrile.
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13
Q

Define preterm labor.

A

The onset of labor before 37 completed weeks of gestation.

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14
Q

What are the causes of preterm labor? (6)

A

Maternal
1. Infections
- Ascending infection ( bacterial vaginosis, candida
- UTI
- Cervicitis
- Febrile illness (e.g., malaria)
2 . Placenta abruption
3 . Uterine malformations (e.g., bicornuate uterus, fibroid uterus)
4 . Cervical weakness/ insufficiency

Fetal
1. PPROM
2. Uterine distension (e.g., multiple pregnancy, macrosomia, polyhydramnios)

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15
Q

What are the maternal risk factors for preterm labor? (10)

A
  1. Age < 18 years
  2. Previous preterm birth
  3. Previous stillbirth
  4. High parity
  5. Anemia
  6. Low socioeconomic status
  7. Hypertensive disorders in pregnancy
  8. Maternal cormobidities- Diabetes
  9. Maternal stress
  10. Infections- malaria, UTI
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16
Q

What are the key management steps for preterm labor? (6)

A
  1. Monitor fetal heart rate and contractions.
  2. Establish IV line with normal saline at maintenance rate.
  3. Send investigations: FBC, urinalysis/urine dipstick, speculum exam.
  4. Perform ultrasound for presentation, AFI, placental location, EFW, EGA, and anatomy.
  5. Administer steroids (Dexamethasone or Betamethasone).
  6. Tocolytic medications to delay delivery for 48 hours (for steroids).
17
Q

What is the role of magnesium sulfate in preterm labor management? (2)

A
  1. Used for neuroprotection in viable EGA <32 weeks with concern for imminent preterm birth.
  2. Should be discontinued at delivery or if delivery is no longer imminent.
18
Q
A

Obs&Gynae (24 decks)

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