PROM (Preterm Premature Rupture of Membranes)
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Questions and Answers

In which of the following scenarios is arresting preterm labor generally contraindicated?

  • Preterm labor at 32 weeks gestation.
  • Gestational diabetes, well-controlled with diet.
  • Cervical dilation of 3 cm with no other complications.
  • Maternal severe hypertension. (correct)

    • A patient presents in preterm labor at 28 weeks gestation. After initial assessment, which intervention is the MOST appropriate FIRST step, according to best practices?

  • Immediate administration of prophylactic antibiotics.
  • Expedited delivery to minimize potential fetal distress.
  • Initiation of tocolytic agents to delay labor and administer corticosteroids. (correct)
  • Strict bed rest and adequate hydration alone.

    • Which of the following tocolytic agents acts through a mechanism MOST directly related to reducing intracellular calcium concentrations in uterine smooth muscle cells?

  • Indomethacin.
  • Nifedipine. (correct)
  • Magnesium sulfate.
  • Ritodrine.

    • During the management of preterm labor, what is the PRIMARY goal concerning the prevention of birth asphyxia and respiratory distress syndrome (RDS) in the neonate?

    <p>Implement continuous intensive clinical monitoring during the first and second stages of labor. (B)</p> Signup and view all the answers

    A patient at 26 weeks gestation presents with possible preterm labor. Transvaginal sonography reveals a cervical length of 25 mm. According to the provided information, what is the MOST appropriate next step in management?

    <p>Obtain a fetal fibronectin (fFN) concentration. (B)</p> Signup and view all the answers

    What are the key factors that influence the management of preterm premature rupture of membranes (PROM)?

    <p>Maternal condition, fetal condition, and gestational age. (D)</p> Signup and view all the answers

    Surveillance for infection is crucial in PROM management when the duration exceeds a certain timeframe. Which of the following durations warrants heightened infection monitoring?

    <p>More than 12 hours (D)</p> Signup and view all the answers

    Which of the following is a significant long-term risk for infants born preterm?

    <p>Cerebral palsy (D)</p> Signup and view all the answers

    A patient is experiencing regular uterine contractions at 32 weeks gestation with documented cervical changes. According to the definitions, what is the most accurate description of her condition?

    <p>Preterm Labor (A)</p> Signup and view all the answers

    A baby is born at 35 weeks gestation. How would this be classified?

    <p>Late preterm (C)</p> Signup and view all the answers

    During a physical examination of a patient presenting with suspected preterm labor, what cervical finding would suggest a significant risk of imminent preterm delivery?

    <p>Effacement of 80% or more (C)</p> Signup and view all the answers

    A sterile speculum exam is performed on a patient presenting with possible premature rupture of membranes (PROM). Besides checking for ROM, what other crucial information can be obtained during this exam?

    <p>Collection of vaginal cultures, GBS culture, and fetal fibronectin. (B)</p> Signup and view all the answers

    What does the presence of fetal fibronectin in vaginal discharge indicate?

    <p>The fetal membranes are not properly attached to the decidua. (C)</p> Signup and view all the answers

    Signup and view all the answers

    Flashcards

    Preterm labor management

    Strategies to prevent and arrest premature birth, including bed rest and tocolytics.

    Tocolytic agents

    Medications used to delay labor allowing time for corticosteroid administration.

    Cervical length significance

    Measurement indicating risk of preterm birth; ≤ 30 mm is low risk, 20-30 mm requires further assessment.

    Risk factors for complications

    Conditions like uncontrolled diabetes and fetal distress that increase labor risks.

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    Neonatal care principles

    Ensure prevention of birth trauma, asphyxia, and manage complications in neonatal units.

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    Preterm Birth (PTB)

    Birth occurring after 28 weeks and before 37 weeks of gestation, regardless of weight.

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    Complications of Preterm Birth

    Preterm birth leading to increased risk of newborn and infant deaths, and long-term issues.

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    Categories of Preterm Birth

    Sub classifications: Late (34-37 weeks), Moderately (32-34), Very (28-32), Extremely (<28).

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    Fetal Fibronectin

    A protein that binds fetal membranes to decidua; indicative in assessing risk for preterm delivery.

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    Cervical Inspection

    Speculum exam used to check for ROM and obtain cultures.

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    Duration of PROM

    Surveillance for infection when Premature Rupture of Membranes exceeds 12 hours.

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    Cervical Length Measurement

    Transvaginal ultrasound showing cervical length <2.5 cm indicates risk for preterm birth.

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    Investigations for Preterm Risk

    Tests including TVS, cultures for infections, and blood tests for treatment planning.

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    Study Notes

    PROM (Preterm Premature Rupture of Membranes)

    • PROM is the rupture of membranes before the onset of labor, after 28 weeks of gestation.
    • Preterm PROM is rupture of membranes before 37 weeks of gestation.
    • Term PROM is rupture of membranes after 37 weeks of gestation.
    • Prolonged PROM is the rupture of membranes for more than 12 hours.
    • The exact cause of PROM is unknown, but many conditions are linked, including maternal infection (e.g., urinary tract infection, sexually transmitted diseases), intrauterine infection, cervical incompetency, and hydramnios.

    Possible Causes of PROM

    • Maternal infections (e.g., urinary tract infections, sexually transmitted diseases)
    • Intrauterine infection
    • Cervical incompetency
    • Hydramnios (excessive amniotic fluid)
    • Decreased tensile strength of membranes

    Effects of PROM

    • PROM is a significant cause of preterm labor, prolapsed cord, placental abruption, and intrauterine infection.
    • Chorioamnionitis (infection of the amniotic membranes and chorion) is a consequence of PROM and can precede endomyometritis or puerperal sepsis.

    Clinical Findings of PROM

    • Symptoms: The key to diagnosis is the patient's report of a sudden gush or continuous leakage of fluid. Additional useful symptoms are the fluid's color, consistency, presence of vernix or meconium, decreased uterine size, and increased fetal prominence on palpation.
    • Sterile Speculum Examination: This is crucial for differentiating PROM from vaginitis or urinary incontinence. Key confirmatory findings are:
      • Pooling of amniotic fluid in the posterior fornix.
      • A positive Nitrazine test (amniotic fluid turns Nitrazine paper blue, indicating alkaline pH).
      • A fern-like pattern of crystallization on a slide after air-drying vaginal fluid (amniotic fluid specific).
    • Further Examination (if no free fluid): If no free fluid is found, a dry pad is placed under the patient to observe for leakage, and ultrasound can be done.

    Natural History of PROM

    • The duration of the latent period (time between PROM and labor) is inversely related to the gestational age at the time of rupture.
    • Less than 26 weeks gestation: 30-40% of women have a latent period of at least a week, and 20% of the women retain fluid beyond 4 weeks.
    • Term pregnancies (after 37 weeks): 80% progress into labor within 24 hours of rupture.

    Management of PROM

    • General Management: Confirm the diagnosis, evaluate maternal and fetal well-being, check for signs of labor, determine gestational age, assess cervical status via sterile speculum examination.
    • Infections: Check for signs of intra-amniotic infection (chorioamnionitis), including maternal fever, tachycardia, fetal tachycardia (FHR over 160 bpm), tenderness of the uterus, offensive cervical discharge, and leukocytosis (elevated white blood cell count).
    • Management Decisions: Management depends on the mother's condition (presence or absence of chorioamnionitis), fetal condition, and gestational age.
    • Infection present: Immediately start treatment with broad-spectrum intravenous antibiotics and ideally induce labor and delivery, promptly. Cesarean section is considered only if abnormal labor occurs. Continue antibiotics post-partum for at least 24hrs until the fever subsides.
    • Preterm PROM (before 37 weeks): Expectant management is prioritized (excluding cases with infection) due to the risks of premature delivery. Goal is to delay labor.
    • Term PROM (after 37 weeks): Wait 8 hours for spontaneous labor to begin. If spontaneous labor does not begin, induce labor. Use antibiotics if the rupture has lasted for more than 12 hours.

    Prediction of Preterm Labor

    • Fetal fibronectin, transvaginal sonography to assess cervical length, and/or triage based on cervical length criteria can be used to predict preterm labor.

    Complications of Preterm Delivery

    • Respiratory distress syndrome (RDS)
    • Birth injury
    • Intraventricular hemorrhage (IVH)
    • Metabolic complications (e.g., hypocalcemia, hypoglycemia, hypomagnesemia, hypothermia)
    • Necrotizing enterocolitis (NEC)
    • Hyperbilirubinemia
    • Infection
    • Malnutrition

    Long-Term Outcomes of Preterm Birth

    • Cerebral palsy
    • Neurosensory impairment
    • Reduced cognition and motor performance
    • Academic difficulties
    • Attention deficit disorders
    • Chronic lung disease
    • Vision and hearing impairment

    Risk Factors for Preterm Birth

    • Spontaneous: maternal conditions, prior pregnancy history, current pregnancy risks, host factors.
    • Iatrogenic: medical interventions.
    • Prior Preterm Delivery: increases the risk by 15-30%
    • Non-white race/ethnicity: Increased Risk
    • Age extremes (<18 or >35 years): increased risk
    • Low socioeconomic status: Increased Risk
    • Low pre-pregnancy weight: Increased Risk
    • Vaginal bleeding: Increased risk
    • Smoking: Increased Risk
    • Physically stressful job (over 40 hrs a week): Increased risk
    • Uterine anomalies: Increased risk
    • Second trimester abortion: Increased risk
    • Preterm rupture of membranes: Increased risk
    • Multiple first trimester abortions: Increased risk
    • Cervical conization: Increased risk
    • Fibroids: Increased risk
    • Polyhydramnios (excessive amniotic fluid): Increased risk
    • DES exposure: Increased risk
    • Anemia: Increased risk
    • Narcotic and cocaine use: Increased risk
    • Periodontal disease: Increased risk
    • Maternal Factors: Low socioeconomic status, non-white race, young or older maternal age, low pregravid weight, smoking, previous preterm delivery.
    • Infection: Chorioamnionitis, sexually transmitted diseases (STDs), bacterial vaginosis (BV).
    • Uterine Factors: Multiple gestation, polyhydramnios, uterine anomalies

    Etiology of Preterm Birth

    • The cause is unknown in 50% of cases
    • Multifactorial origin associated with risk factors.
    • Maternal complications in current pregnancy (APH, PROM, preeclampsia etc), fetal issues, uterine abnormalities, infections, and iatrogenic causes.

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    Related Documents

    PROM & Preterm Labor PDF

    Description

    PROM involves membrane rupture before labor after 28 weeks. Preterm PROM occurs before 37 weeks, while term PROM is after. Prolonged PROM lasts over 12 hours. Causes include maternal infections, cervical issues and hydramnios.

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