Premature rupture of membranes resident survival guide: Difference between revisions
Agnesrinky (talk | contribs) No edit summary |
Agnesrinky (talk | contribs) |
||
Line 42: | Line 42: | ||
==Diagnosis== | ==Diagnosis== | ||
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to the [...] guidelines. | Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according to the [...] guidelines. | ||
{{Family tree/start}} | |||
{{Family tree | | | | | | | A01 | | | | | | | |A01= [[Pregnant]] woman comes with [[Premature rupture of membranes]]}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B01 | | | | | | | |B01= Take complete history}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B02 | | | | | | | |B02= <div style="float: left; text-align: left; height: 20em; width: 15em;; "> '''Record the [[Vital signs|vitals]]:'''<br> | |||
---- | |||
❑ [[Blood pressure]]<br><br> | |||
❑ [[Temperature]]<br><br>❑ [[Respiratory rate]]<br><br>❑ [[Heart rate]] </div>| | | | | | | |}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B02 | | | | | | | |B02= <div style="float: left; text-align: left;"> '''Take [[obstetric]] history :'''<br> | |||
---- | |||
❑ Date of last [[menstrual]] period? <br><br>❑ Estimated date of [[delivery]].<br><br>❑ Confirm the [[gestational]] age, [[gravidity]] and [[parity]].<br><br> ❑ Check if this is a single or multiple [[gestation]].<br><br> </div>| | | | | | | |}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B01 | | | | | | | |B01= <div style="float: left; text-align: left;"> '''Ask about previous obstetric history if she was previously [[pregnant]] :'''<br> | |||
---- | |||
❑ Ask about previous pregnancies including [[miscarriages]] and [[Termination of pregnancy|terminations]]. <br><br>❑ Length of [[gestation]]. <br><br>❑ Ask about mode of delivery. <br><br>❑ Ask if there was similar complaints during previous [[pregnancy]]?<br><br>❑ Was there any complications throughout the [[pregnancy]] or during [[delivery]] such as [[shoulder dystocia]], [[postpartum haemorrhage]] ?<br><br></div>| | | | | | | | }} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B02 | | | | | | | |B02= <div style="float: left; text-align: left;"> '''Ask the following questions about [[menstrual]] history :'''<br> | |||
---- | |||
❑ Age of [[menarche]] <br><br>❑ Last [[menstrual]] period<br><br>❑ Is the [[menstrual]] flow normal? How many pads she has to use in a day? <br><br>❑ Is there any foul smell or colour change?<br><br>❑ How many days does the [[menstruation]] stay?<br><br>❑ [[Contraceptive]] history for example [[oral]] [[contraceptives]], [[intrauterine device]]<br><br></div>| | | | | | | |}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B02 | | | | | | | |B02= <div style="float: left; text-align: left;"> '''Do Speculum examination :'''<br> | |||
---- | |||
❑ Visualization of amniotic fluid (AF) leaking through the cervix<br><br> | |||
❑ Vaginal pooling<br><br> | |||
❑ Fern test of dried vaginal fluid seen under microscope<br><br> | |||
❑ pH testing : | |||
*Normal: 3.8 to 4.5 <br><br> | |||
*Amniotic Fluid: 7.1 to 7.3 <br><br> | |||
*False positives: Blood or semen, alkaline antiseptics <br><br> | |||
*False negatives: Minimal remaining amniotic fluid following rupture<br><br> | | | | | | | |}} | |||
{{Family tree | | | | | | | |!| | | | | | | | |}} | |||
{{Family tree | | | | | | | B02 | | | | | | | |B02= <div style="float: left; text-align: left;"> '''If above are not conclusive, do the following tests :'''<br> | |||
---- | |||
❑ Ultrasound for AFV may be helpful but not diagnostic . <br><br> | |||
❑ Fetal fibronectin is sensitive with high negative predictive value but positive result is not diagnostic<br><br> | |||
❑ Amniotic protein tests have high sensitivity for PROM but false-positive rates are high.<br><br> | |||
{{familytree/end}} | |||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} |
Revision as of 16:29, 23 February 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.
Synonyms and keywords:
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Common risk factors in the development of PROM include :
- Maternal risk factors:
- Sepsis
- Previous history of PROM, recurrence risk is 16%–32% as compared with 4% in women with a prior uncomplicated term delivery.
- Chronic steroid therapy
- Abnormal bleeding during the second trimester or late in the pregnancy.
- Low body mass index (BMI < 19.8 kg/m2)
- Smoking and drug abuse
- Low socioeconomic status
- Deficiency of copper or vitamin C, along with connective tissue disorders such as Ehlers-Danlos syndrome, Systemic Lupus Erythematosus are also linked to increased risk of PROM.
- Direct abdominal trauma
- Preterm labor
- Anemia
- Uteroplacental Factors:
- Uterine anomalies (such as uterine septum)
- Placental abruption
- Advanced cervical dilation (cervical insufficiency)
- Prior cervical conization
- Cervical shortening in the 2nd trimester (< 2.5 cm)
- Uterine overdistention (Polyhydramnios, Multiple pregnancy)
- Intra-amniotic infection (Chorioamnionitis)
- Multiple bimanual vaginal examinations (but not sterile speculum or transvaginal ultrasound examinations)
- Fetal factors include :
- Multiple pregnancy ( preterm PROM complicates 7%–10% of twin pregnancies)
- Prematurity
- Infection
- Cord prolapse
- Malpresentation. [1]
Diagnosis
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according to the [...] guidelines.
{{Family tree | | | | | | | B02 | | | | | | | |B02=❑ Ultrasound for AFV may be helpful but not diagnostic .
❑ Fetal fibronectin is sensitive with high negative predictive value but positive result is not diagnostic
❑ Amniotic protein tests have high sensitivity for PROM but false-positive rates are high.
Pregnant woman comes with Premature rupture of membranes | |||||||||||||||||||||||||||||||||||||||||||||||
Take complete history | |||||||||||||||||||||||||||||||||||||||||||||||
Ask about previous obstetric history if she was previously pregnant : ❑ Ask about previous pregnancies including miscarriages and terminations. ❑ Length of gestation. ❑ Ask about mode of delivery. ❑ Ask if there was similar complaints during previous pregnancy? ❑ Was there any complications throughout the pregnancy or during delivery such as shoulder dystocia, postpartum haemorrhage ? | |||||||||||||||||||||||||||||||||||||||||||||||
Ask the following questions about menstrual history : ❑ Age of menarche ❑ Last menstrual period ❑ Is the menstrual flow normal? How many pads she has to use in a day? ❑ Is there any foul smell or colour change? ❑ How many days does the menstruation stay? ❑ Contraceptive history for example oral contraceptives, intrauterine device | |||||||||||||||||||||||||||||||||||||||||||||||
Do Speculum examination : ❑ Visualization of amniotic fluid (AF) leaking through the cervix
| |||||||||||||||||||||||||||||||||||||||||||||||
History suggestive of PROM<be>(leakage of fluid from the vagina) | |||||||||||||||||||||||||||||
Physical examination findings confirm PROM •Pooling of fluid •Positive nitrazine and Ferning tests | |||||||||||||||||||||||||||||
Sterile speculum examination assess dilation and ultrasound if indicated | |||||||||||||||||||||||||||||
PROM ruled-out | PROM confirmed | ||||||||||||||||||||||||||||
Check gestational age •Arrange transportation to tertiary care if possible •Arrange prompt consult with obstetrician •Fetal non-stress test and ECG to assess well being | |||||||||||||||||||||||||||||
Induce delivery with oxytocin if at-term gestation | Plan delivery if any signs of infection, placental insufficiency, fetal distress, or active labor | ||||||||||||||||||||||||||||
24-31 weeks •Antibiotics+steroids •Delivery if lung maturity is satisfactory | 32-33 weeks •Antibiotics+steroids •Delivery at 34 weeks or amniocentesis if abortion is suspected | 34-36 weeks •Group B strep prophylaxis •Delivery | |||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Naeye RL (1982). "Factors that predispose to premature rupture of the fetal membranes". Obstet Gynecol. 60 (1): 93–8. PMID 7088456.