PROM.pptx,( Prelabor repture of membrane)

This premature Rupture of membrane ppt

1. Premature Rupture of membrane( PROM)

2. Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor.[2] Women usually experience a painless gush or a steady leakage of fluid from the vagina.[1] Complications in the baby may include premature birth, cord compression, and infection.[1][2] Complications in the mother may include placental abruption and postpartum endometritis . [2]

3. 2. Epidemiology Of term pregnancies (more than 37 weeks) about 8% are complicated by PROM, 20% of these become prolonged PROM. About 30% of all preterm deliveries (before 37 weeks) are complicated by PPROM, and rupture of membranes before viability (before 24 weeks) occurs in less than 1% of all pregnancies. Since there are significantly fewer preterm deliveries than term deliveries, the number of PPROM cases make up only about 5% of all cases of PROM.

4. 3. Pathophysiology Weak membranes Fetal membranes likely break because they become weak and fragile. This weakening is a normal process that typically happens at term as the body prepares for labor and delivery. However, this can be a problem when it occurs before 37 weeks (preterm). The natural weakening of fetal membranes is thought to be due to one or a combination of the following. In PROM, these processes are activated too early:

Cell death: when cells undergo programmed cell death, they release biochemical markers that are detected in higher concentrations in cases of PPROM.
Poor assembly of collagen: collagen is a molecule that gives fetal membranes, as well as other parts of the human body such as the skin, their strength. In cases of PPROM, proteins that bind and cross-link collagen to increase its tensile strength are altered.
Breakdown of collagen: collagen is broken down by enzymes called matrix metalloproteinases (MMPs), which are found at higher levels in PPROM amniotic fluid. This breakdown results in prostaglandin production which stimulates uterine contractions and cervical ripening. MMPs are inhibited by tissue inhibitors of matrix metalloproteinases (TIMPs) which are found at lower levels in PPROM amniotic fluid.[10]

5. Continue……… Cell death: when cells undergo programmed cell death, they release biochemical markers that are detected in higher concentrations in cases of PPROM. Poor assembly of collagen: c ollagen is a molecule that gives fetal membranes, as well as other parts of the human body such as the skin, their strength. In cases of PPROM, proteins that bind and cross-link collagen to increase its tensile strength are altered.

6. Continue……… Breakdown of collagen: collagen is broken down by enzymes called matrix metalloproteinases (MMPs), which are found at higher levels in PPROM amniotic fluid. This breakdown results in  prostaglandin  production which stimulates uterine contractions and  cervical ripening . MMPs are inhibited by tissue inhibitors of matrix metalloproteinases (TIMPs) which are found at lower levels in PPROM amniotic fluid.

7. Risk Factors The cause of PROM is not clearly understood, but the following are risk factors that increase the chance of it occurring. In many cases, however, no risk factor is identified. Infections : urinary tract infection, sexually transmitted diseases, lower genital tract infections (e.g. bacterial vaginosis ), infections within the amniotic sac membranes ( chorioamnionitis )
Tobacco use during pregnancy
Illicit drug use during pregnancy
Having had PROM or preterm delivery in previous pregnancies Polyhydramnios : too much amniotic fluid
Multiple gestation: being pregnant with two or more fetuses at one time
Having had episodes of bleeding anytime during the pregnancy
Invasive procedures (e.g. amniocentesis )
Nutritional deficits
Cervical insufficiency: having a short or prematurely dilated cervix during pregnancy
Low socioeconomic status
Being underweight

8. Differential Diagnosis Other conditions that may present similarly to premature rupture of membranes are the following: Urinary incontinence: leakage of small amounts of urine is common in the last part of pregnancy
Normal vaginal secretions of pregnancy
Increased sweat or moisture around the perineum Increased cervical discharge : this can happen when there is a genital tract infection
Semen
Douching Vesicovaginal fistula : an abnormal connection between the bladder and the vagina
Loss of the mucus plug