Preterm Premature Rupture Of Membranes (PPROM)

Preterm Premature Rupture Of Membranes

Block 4.3 Life Cycle III (Obstetrics Week)

College of Medicine, King Faisal University

Al-Ahsa, Saudi Arabia

1. Preterm Premature Rupture Of Membranes Abdullatiff Sami Al-Rashed Block 4.3 (Life Cycle III) College of Medicine, King Faisal University Al- Asha , Saudi Arabia

2. 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.

3. Etiology & Risk Factors

4. Signs & Symptoms

5. Diagnosis 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.

6. Diagnosis 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.

7. Diagnosis Once membrane rupture has been confirmed, digital examination of the cervix SHOULD BE AVOIDED until labor or induction of labor.

8. Diagnosis Endocervical samples may be considered for gonorrhea and chlamydia testing if clinically indicated. Group B streptococcus cultures are obtained.

9. Diagnosis Fetal heart rate and uterine activity monitoring are used to assess fetal well-being and uterine contraction pattern.

10. Diagnosis 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.

11. Differential Diagnosis The differential diagnoses for PROM include:

12. Complications

13. Management

14. References

15. Thank You AL-AHSA