Date post: | 16-Apr-2017 |
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Preterm Premature Rupture Of MembranesAbdullatiff Sami Al-RashedBlock 4.3 (Life Cycle III)College of Medicine, King Faisal University Al-Asha, Saudi Arabia
+Definition
PPROM is rupture of fetal membranes prior to 37 weeks’ gestation.
It is a leading cause of neonatal morbidity and mortality and is associated with approximately 30% of preterm deliveries.
+Etiology & Risk Factors
Intrauterine infection
STDs Prior PPROM
Smoking(risk of
PPROM is doubled in mothers
who smoke during
pregnancy)
Multiple Gestation
Other
+Signs & Symptoms
Other symptoms includes flecks of meconium in the fluid, decrease in the size
of the uterus or change in color and consistency of fluid coming out of the
vagina.
The main symptom is sudden painless gush of fluid leaks out of the vagina or a steady leakage of small amounts of watery fluid.
+Diagnosis
1. A sterile speculum examination is first performed to evaluate the fetal membrane status and to inspect the cervix:
Membrane rupture is confirmed by visualization of amniotic fluid in the posterior fornix or by passing of amniotic fluid from the cervical canal.
+Diagnosis
2. Nitrazine Test: The nitrazine test uses pH to distinguish amniotic fluid
from urine and vaginal secretions.
Amniotic fluid is alkaline, having a pH above 7.1; vaginal secretions have a pH of 4.5 to 6.0, and urine has a pH of ≤6.0.
To perform the nitrazine test, a sample of fluid obtained from the vagina during a speculum examination is placed on a strip of paper or swab impregnated with nitrazine. If the pH is 7.1 to 7.3, reflecting that of amniotic fluid, the paper or swab turns dark blue.
+Diagnosis
Once membrane rupture has been confirmed, digital
examination of the cervix SHOULD BE AVOIDED until labor
or induction of labor.
+Diagnosis
3. Endocervical samples may be considered for gonorrhea and chlamydia testing if clinically indicated.
4. Group B streptococcus cultures are obtained.
+Diagnosis
5. Fetal heart rate and uterine activity monitoring are used to assess fetal well-being and uterine contraction pattern.
+Diagnosis
6. Ultrasound: Ultrasonography can be helpful in evaluating the possibility
of rupture of membranes.
If ample amniotic fluid around the fetus is visible on ultrasound examination, the diagnosis of PROM must be questioned.
+Differential Diagnosis
The differential diagnoses for PROM include:
Urinary incontinence
Increased vaginal secretions in pregnancy (physiologic)
Infections
Exogenous fluids (such as semen or douche).
+Complications
+Management
+References
Thank You
AL-AHSA