recent posts

RUPTURE OF MEMBRANES

image
Premature ROM 

  • rupture of membranes prior to the onset of labour at any GA
Prolonged ROM

  • if 24 hours elapse between rupture of membranes and onset of labour
Preterm ROM

  • ROM occurring before 37 weeks gestation (associated with PTL)

PPROM

  • preterm premature rupture of membranes (not in labour)

Associated Conditions

  • congenital anomaly
  • infection

Causes

  • idiopathic (most common)
  • frequently associated with
    1. multiparity
    2. cervical incompetence
    3. infection: cervicitis, vaginitis, STD, UTI
    4. multiple gestation
    5. family history of PROM
    6. low socioeconomic class/poor nutrition
    7. and other risk factors associated with PTL (see above)
Complications

  1. cord prolapse
  2. intrauterine infection (chorioamnionitis)
  3. premature delivery
Diagnosis

  1. history of fluid gush or continued leakage
  2. avoid introducing infection with examinations (do not do a digital pelvic exam)
  3. sterile speculum exam
  4. pooling of fluid in the posterior fornix
  5. may observe fluid leaking out of cervix on valsalva
  6. amniotic fluid turns nitrazine paper blue (low specificity as can be blood, urine or semen)
  7. ferning (high salt content of amniotic fluid evaporates and looks like ferns under microscope)
  8. U/S
Management

  1. cultures (cervix for GC, lower vagina for GBS)
  2. dependent upon gestational age; must weigh degree of prematurity vs risk of amnionitis and sepsis by remaining in utero
    • < 24 weeks consider termination (poor outlook due to pulmonary hypoplasia)
    • 26-34 weeks: expectant management as prematurity complications significant
    • 34-36 weeks: ìgrey zone" where risk of death from RDS and neonatal sepsis is the same
    • > 36 weeks: induction of labour since the risk of death from sepsis is greater than RDS
  3. assess fetal lung maturity by L/S ratio of amniotic fluid
  4. consider administration of betamethasone to accelerate maturity
  5. if not in labour or labour not indicated, consider antibiotics (controversial)
  6. admit and monitor vitals q4h, daily BPP and WBC count
RUPTURE OF MEMBRANES RUPTURE OF MEMBRANES Reviewed by Radiology Madeeasy on December 25, 2010 Rating: 5
Powered by Blogger.