Ruptured Membrane

Question 1

A 27 year old woman in her second pregnancy presents at 32 weeks gestation with a sudden gush of clear fluid from her vagina. She has no contractions and has had no show. You suspect she has ruptured her membranes.

a. List 2 complications of ruptured membranes. (2)

Answer 1

1. Preterm labour
2. Infection → chorioamnionitis
3. Foetal distress / death
4. Placental abruption
5. Cord prolapse

Question 2

b. You arrange for her admission and perform a sterile speculum examination. What observations would you make and/or what investigations would you perform during the speculum exam? List 3. (3)

Answer 2

Observations:

1. Visualise amniotic fluid draining through cervix
2. Degree of dilatation of cervix
3. Check for pooling of blood in posterior fornix
4. Look for offensive yellow/brown discharge

Investigations:

1. High vaginal swab for infective agents (e.g. Chlamydia Trachomatis)
2. Chorioamniocentesis

Question 3

c. List 3 variables that you would wish to monitor to try and identify the early onset of possible complications. (3)

Answer 3

1. Pre-term labour: dilation of cervix, uterine contractions, foetal HR
2. Chorioamnionitis: maternal temperature, WCC/CRP levels, uterine tenderness
3. Foetal distress on CTG

Question 4

d. The baby is delivered. In the first 4 hours after delivery what respiratory signs in the infant would suggest Respiratory Distress Syndrome? List 2. (2)

Answer 4

1. Cyanosis
2. Nasal flaring
3. Intercostal indrawing
4. Subcostal recession