Premature rupture of membrane

Short discussion on Premature rupture of membrane
Definition, Cause, types, Clinical feature, Management

1. By Intern Dr. Borhan Uddin. PREMATURE RUPTURE OF MEMBRANE

2. Definition - Spontaneous rupture of the membrane any time after the age of viability but before the onset of labor is called premature rupture of membrane. Incidence of PROM- 10 % of all pregnancy .

3. Causes of PROM -Exact cause is not known- Obstetrical cause- 1. Multiple pregnancy. 2. P olyhydramnios 3. Malpresentation and contracted pelvis Maternal infection- 1. UTI . 2. Lower genital tract infection. 3. Chorioamnionitis. 4. Cervical incompetence. 5. Frequent coitus in last month

4. Diagnosis of PROM- a ) History. b ) Examination c ) Investigation.

5. History - Sudden escape of watery discharge per vagina either in the form of gush or slow leak. Examination -If chorioamnionitis is developed then sign of infection. 1 ) Fever. 2 ) Tachycardia. 3 ) Uterine tenderness. 4 ) Foul smelling discharge. Confirmation of diagnosis- Sterile speculum examination shows liquor escaping out through the cervix and then examine the fluid.

6. How we confirm that it is liquor or other fluid? Detection of PH by litmus or nitrazine paper- Normal vaginal PH is -4.5-5.5.If it is liquor then PH-7-7.5. Fern test- Fluid from posterior fornix is placed on a slide and allowed to dry. Amniotic fluid from a fern like pattern of crystallization. Nitrazine test- a sterile cotton tipped swab should be used to collect fluid from posterior fornix and apply it to nitrazine paper. If it is amniotic fluid then the paper turns into blue.

7. Hydrorrhoea gravidarum. Incontinence of urine especially in later month. Differential Diagnosis-

8. Investigations - CBC-Neutrophilic leukocytosis in case of chorioamnionitis. Urine for R/E. High vaginal swab for culture and sensitivity test. USG for monitoring the fetal well -being.

9. To start prophylactic antibiotics- Need To asses gestational age. Patient not in labor. Absence of infection and fetal distress. Management of PROM-

10. Maternal- preterm labor. Infection. Increase chance of cord prolapse. Prolong labor. Fetal – High perinatal mortality and morbidity. Neonatal infection. Complications-

11. Thank you