PREMATURE RUPTURE OF MEMBRANCES

					PREMATURE RUPTURE OF
  MEMBRANES (PROM)



     Lin Qi De
          Definition
PROM is defined as the rupture
of the chorioamniotic
membrane before the onset of
labor
       Incidence
PROM occurs in about
 10%~15% of all delivery
PROM is associated with
 10% of term pregnancy
           Cause of PROM

 Trauma (abdominal striked intensely)
 Sexual intercourse(particularly in the late
  gestational weeks)
 Vaginal infection
   due to bacteria、virus、TOXO、CMV、HPV
  and HSV,et al
 Smoking
 Other :
Prior PROM
A short cervical length
Prior preterm delivery
Bleeding in early pregancy
        Affect of PROM on the
         mothers and infants

Mothers:
(1) Infection : intrauterine
                 puerperal
(2) Placental abruption
(3) Preterm delivery
    Infants:
(1) Preterm Baby and their Complications :
    (RDS / Fetal and Neurologic dysfunction
     Intracranial hemorrhage)
(2) neonatal pneumonia、sepsis
(3) Pulmonary hypoplasia and fetal
  compression syndrone
(4) Prolapse or compression of umbilical cord
(5) Abruptio placenta
    Clinical manifestation

(1) Fluid passing through the vagina suddenly,
  and then small amounts of fluid flow
  through the vagina intermitently,
  particularly when the increased of
  abdorminal pressure (cough,sneeze,et al)
(2) Free flowing amniotic fluid

(3) Fever / heart rate of mother and
    infants ↑ / WBC and CRP ↑/ Uterine
    tenderness on palpation
         Diagnosis

(1) Vaginal speculum exam.:
    leakage of amniotic fluid
(2) PH determination of vaginal fluid
(3) The “fern” test
(4) Aminoscopy
            Management
PROM at term:
(1) Awaiting the onset of spontaneous labor for 12-24h
(2) Termination of pregnancy after 24 hours

PROM before term:
  Termination of pregnancy
(1) Evidence of fetal pulmonary maturation
(2) Evidence of inturine infection
Expectant therapy
Indication :
(1) Evidence of fetal pulmonary inmaturation
(2) Without evidence of inturine infection
Management:
(1)To enhance fetal pulmonary maturation
(2) Antibiotic
(3) Tocolysis

				
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posted:4/25/2011
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