PREMATURE RUPTURE OF MEMBRANES (PROM)
A 22-year-old primigravida at 33 weeks’ gestation comes to the birthing unit stating that 2 h ago she had a gush of fluid from her vagina. She denies vaginal bleeding or uterine contractions. Her perineum appears moist to gross inspection. On examination her temperature is 102°F.
Definition. Rupture of the fetal membranes before the onset of labor, whether at term or preterm.
Risk Factors. Ascending infection from the lower genital tract is the most common risk factorfor PROM. Other risk factors are local membrane defects and cigarette smoking.
OB Triad
Indomethacin
• Preterm labor tocolysis
• Oligohydramnios
• PDA closure in utero
OB Triad
Ruptured Membranes
• Posterior fornix pooling
• Fluid is Nitrazine
(phenaphthazine) (+)
• Glass slide drying: fern (+)
71
| S2 OB-GYN.indb 71 | 7/8/13 6:35 PM | |||
GI
USMLE Step 2 l Obstetrics
Clinical Presentation. Typical history is a sudden gush of copious vaginal fluid. On externalexamination, clear fluid is flowing out of the vagina. Oligohydramnios is seen on ultrasound examination.
Diagnosis.
PROM is diagnosed by sterile speculum examination meeting the following criteria:
• Pooling positive—clear, watery amniotic fluid is seen in the posterior vaginal fornix
• Nitrazine positive—the fluid turns pH-sensitive paper blue
• Fern positive—the fluid displays a ferning pattern when allowed to air dry on amicroscope glass slide
Chorioamnionitis is diagnosed clinically with all the following criteria needed:
• Maternal fever and uterine tenderness in the presence of confirmed PROM in the absence of a URI or UTI
OB Triad
Chorioamnionitis
• Ruptured membranes
• Maternal fever
• No UTI or URI
With permission, Australian Society of Cytology Inc., cytology-asc.com
Figure I-8-3. Ferning Pattern of Amniotic Fluid
Management
• If uterine contractions occur, tocolysis is contraindicated.
• If chorioamnionitis is present, obtain cervical cultures, start broad-spectrum therapeutic IV antibiotics, and initiate prompt delivery.
|
|
|
• If no infection is present, management will be based on gestational age as follows:
– Before viability (<24 weeks), outcome is dismal. Either induce labor or managepatient with bed rest at home. Risk of fetal pulmonary hypoplasia is high.
– With preterm viability (24–33 weeks), conservative management. Hospitalize thepatient at bed rest, administer IM betamethasone to enhance fetal lung maturity if <32 weeks, obtain cervical cultures, and start a 7-day course of prophylactic ampi-cillin and erythromycin.
– At term (≥34 weeks), initiate prompt delivery. If vaginal delivery is expected, useoxytocin or prostaglandins as indicated. Otherwise, perform cesarean delivery.
72
| S2 OB-GYN.indb 72 | 7/8/13 6:35 PM | |||
GI
Chapter 8 l Obstetric Complications
Дата добавления: 2018-11-24; просмотров: 253; Мы поможем в написании вашей работы! |
Мы поможем в написании ваших работ!