Powerpoint Presentation on the topic PROM.pptx

Gynaecological

1. PROM (Premature rupture of membrane) Definition: Spontaneous rupture of membranes after 28 weeks of gestation before the onset of labor. Term PROM: Rupture of membranes after 37 weeks 
 Preterm PROM : Before 37 weeks 
 Prolonged PROM: Longer than 18 hrs / 12 hrs. 
 Latency period: Time between rupture of membranes to onset of labor .

2. Diagnosis History : complaint of leakage of liquor as gush or slow l eak followed by intermittent leakage 
 Sterile speculum examination with or without valsalva maneuver( leakage or pooling) 
 Nitrazine paper test : principle is alkaline nature of amniotic fluid(accuracy of approximately 93%) Became blue
False + ve - blood , semen, alkaline urine, bacterial vaginosis ,

3. Diagnosis Ferning pattern : A ccuracy of diagnosis of PROM of approximately 96% False + ve : contamination by semen or cervical mucus False – ve : dry swab, contamination with blood at a 1:1 dilution, or not allowing sufficient time for the fluid to dry on the slide Ultrasound: support diagnosis & fetal wellbeing.

4. I nvestigations CBC
Urine analysis(Culture & Sensitivity)
High vaginal swab for culture & Sensitivity
 Biophysical profile 
CTG for non-stress test

5. Differential diagnosis Urinary incontinence Leucorrhea gravidarum Vaginal discharge-pathological

6. Incidence Average 5- 10% of all deliveries and up to 30% of preterm deliveries. Approximately 70% of cases of PROM occur in pregnancies at term. PROM is the clinically recognized precipitating cause of about one third of all preterm births.

7. Causes (multifactorial) Intrinsic membrane weakness Infections Smoking Malnutrition Collagen Deficiency 2 . Infection 
 3 . Mechanical stress Twin gestation Polyhydramnios Fetal Malformations 4 . Unknown

8. Complications Labor: In term PROM labor starts in 24 hours in about 90%. In Preterm PROM, labor starts in 70-80% of cases in one week time Ascending infection Increased incidence of cord prolapse Fetal pulmonary hypoplasia Prematurity Operative delivery Abruption placenta

9. Management of PROM Accurate diagnosis 
Avoid digital vaginal examination Bed rest 
 Management depends on : Gestational age Presence or absence of labor Infection or not Fetal condition

10. Indications for pregnancy termination in PROM Term PROM 
 Labor 
 Presence of infection 
 IUFD 
 Congenital anomalies of fetus incompatible to life 
 Abnormal fetal surveillance

11. Preterm PROM GA > 34 weeks- is controversial either conservative management or termination GA < 34 weeks- conservative management

12. Components of conservative management Monitor maternal Pulse rate,Temp , BP FHR every 4 hours CBC ,U/A,ESR/ CRP twice per week BPP / NST twice per week Corticosteroids if less than 32/34 weeks Administer antibiotics: ampicillin (iv)+ erythromycin X 48hrs followed by amoxacillin ( po ) & erythromycin to complete a total of seven days

13. Chorioamnionitis Criteria for clinical chorioamnionitis : Maternal temperature > 38 o C Uterine tenderness Foul smelling amniotic fluid High WBC count(>16000/18000) Maternal &/ or fetal tachycardia 


14. Management of chorioamnionitis Antibiotics : Ampicillin+ Gentamycin+ 
clindamycin/metronidazole/chloramphenicol 
 Ceftriaxone +/- metronidazole 
 Terminate pregnancy: Vaginal route is preferred  

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