Premature Rupture of Membranes (Prom)

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Transcript of Premature Rupture of Membranes (Prom)

PREMATURE RUPTURE OF MEMBRANES (PROM)KABERA Ren, MD Resident PGY II- Family and Community Medicine Obs-Gyn. Dept Ruhengeri Hospital Feb 2010.

ESSENTIALS OF DIAGNOSIS History of a gush of fluid from the vagina or watery vaginal discharge. Demonstration of amniotic fluid leakage from the cervix. 1h before the onset of labor.

KABERA Ren ,MD PGY II FAMCO NUR

General Considerations Rupture of the membranes may happen at any time during pregnancy. It becomes a problem if the fetus is preterm (preterm) . >24 Hrs, prolonged premature rupture of membranes -time between rupture of the membranes and the onset of labor is.

KABERA Ren ,MD PGY II FAMCO NUR

General considerations ct Causes Infections . Cervix incompetency. Hydramnios 10.7 % in all pregnancy. 94% mature fetus (>2500 grs) ,5% premature fetus (1000-2500 grs),immature fetus 0.5%(16000 WBC),uterine tenderness, tachycardia ( >100 btm-mother,>160 btm-fetus ),foul smelling amniotic liquid .

KABERA Ren ,MD PGY II FAMCO NUR

Management A.Amniotitis : delivery regardless of gestational age. Broadspectrum antibiotics should be started. if no labor , labor should be induced to expedite delivery. B. Term Pregnancy Without Amnionitis: Nonintervention is an acceptable initial course of treatment, but if the patient does not go into labor within 6-12 hours after PROM, labor should be induced to minimize the risk of infection.KABERA Ren ,MD PGY II FAMCO NUR

Management ct C. Preterm Pregnancy Without Amnionitis Pregnancies beyond 33-34 weeks' EGA can be managed as a term pregnancy because there is no evidence that antibiotics, corticosteroids, or tocolytics improve outcome in these patients. Pregnancies prior to 24 weeks' EGA with PROM have extremely low rates of fetal salvage with considerable maternal risk. Furthermore, at this early gestational age, steroids, tocolytics, and antibiotics have no proven benefit.KABERA Ren ,MD PGY II FAMCO NUR

Management ct For pregnancies with PROM between 24 and 32 weeks' EGA. Antibiotics. Corticosteroids. Tocolytics :In the preterm PROM patient should be limited to 48 hours duration.

KABERA Ren ,MD PGY II FAMCO NUR

References Current Obs-Gyn diagnosis and treatment.2003 Williams Obstetrics .2005 The Merck manual of diagnosis and therapy.1999

KABERA Ren ,MD PGY II FAMCO NUR

Thank youMurakozeKABERA Ren ,MD PGY II FAMCO NUR