Question 5: (P)ROM

Question 1

Diff dx for loss of fluid from the vagina

Answer 1

• ruptured membranes
• urine leak
• discharge (infection)
• normal discharge

Question 2

Detail how you would assess them.

Answer 2

HISTORY: timing, nature, volume of fluid
sx of labour (contractions, tightenings)
infection sx
fetal movements
double check accuracy of dates - PROM?
Preg care to date - any concerns
Group B strep status
Obstetric hx - deliveries, issues
prev bleeding in pregnancy, smoking
Sexual hx

EXAM
maternal temp/pulse - infection
abdo exam (fetal lie, presentation, fundal height, FHR)
sterile speculum - liquor? meconium? blood? cervical dilatation

INVESTIGATION
test fluid with swab - check pH/amnisure
Swab for infections (GBS, BV, chlamydia, gonorrhea)
MSU, FBC, CRP
CTG

Question 3

Management at 39/40

Answer 3

Assess for NVD vs CS (e.g. breech, e.g. fetal distress, e.g. prev CS, if scheduled for elective CS)

Expectant management - e.g. at home if they meet certain criteria such as no GBS risk factors

Consider augmentation/induction, for example if she is GBS +ve or there is meconium indicating fetal distress
+/- antibiotic cover (unsure of Palmy, but in Lakes DHB they give abx when labour begins/IOL commences).

Question 4

Management at 29/40

Answer 4

Admit

PO erythromycin for 10/7
Steroids as <35 weeks
Tocolysis if no infection to allow steroids to work
Mag sulphate for neuroprotection

Deliver immediately if chorioamnionitis or fetal distress