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PPROM & Chorioamnionitis (PPROM (Etiology of PPROM (Similar etiology…

- - - - Multifetal gestation, Polyhydramnios
      - Short Cx length
      - 2nd half bleeding
      - Low BMI, low socioeconomic status
      - Cigarette smoking and illicit drug use
  - - - Fluid leakage
      - Amount of secretion
    - - Sterile speculum exam
        
        purpose: minimize risk of introduce infection therefore, not using PV as it increase risk of infection and add a lil info for mx
        
        :check: confirmation of ruptured membrane, assess Cx dilatation/Cervititis, Umbilical Ford prolapse, Fetal presentation, Obtain U/C (if it’s preterm)
        
        Dx when
        
        visualization of amniotic fluid passing fr Cx (Cough test -> :arrow_up: intra-abdominal pressure 2. pooling amniotic fluid in Vx
    - - pH test (Nitrazine paper)
        
        Normal pH of Vx secretions: 4.5 - 6.0
        
        Amniotic fluid pH: 7.1 - 7.3
        
        FALSE :warning:
        
        Positive: Blood contamination, Semen, BV
        
        Negative: Prolonged ROM, Anhydramnios
        
        Positive when pH paper turn color into Dark blue
      - Fern test
        
        Aware points
        
        Sample of fluid put on Air dry slide
        
        3 cm from Cx Os must beware of contamination
        
        FALSE :warning:
        
        Positive: Cervical mucosa
        
        Negative: Prolonged ROM, Anhydramnios
      - Nile blue test
        
        Using ‘Nile blue sulphate’
        
        Fetal fat cells will turn into :red_circle:
        
        Sample + Dye -> Heat dry
        
        FALSE :warning:
        
        Positive: -
        
        Negative: Early GA < 36 wks
      - U/S
        
        Useful in adjunct
        
        not diagnostic
        
        Use to measure AFI (4 quadrants)
  - - - GA
      - Clinical infection
      - Fetal status
    - - PE
      - Lab
      - Imaging
    - - Delivery at any GA
      - Chronologic mx (GA based)
        
        Term & Late Preterm (≥ 34 wks)
        
        Early term & Term (≥ 37 wks)
        
        Proceed to delivery
        
        GBS prophylaxis as I/C
        
        Late Preterm (34 - 36+6 wks)
        
        Same as Early term and Term
        
        Early Preterm (24 - 34 wks)
        
        Expectant Mx
        
        ATBs rec to prolong latency if no C/I
        
        Purpose: to prevent ascending infection so Prolong preg and Delay progession to Preterm birth
        
        Regimens
        
        Ampicillin 2 g IV q 6 hrs + Erythromycin 250 mg IV q 6 hrs for 48 hrs
        
        FOLLOWED BY Amoxicillin 250 mg oral q 8 hrs + Erythromycin 333 mg oral q 8 hrs for 5 days
        
        Single course corticosteroids
        
        GBS prophylaxis as I/C
        
        Periviable (< 24 wks)
        
        :star: Patient counseling that lung hypoplasia might happen from oligohydramnios
        
        :star: Expectant Mx or Induction of labor
        
        :star: IV given (NSS or Ringer lactate) as hope to increase AF
        
        ATBs mayb considered as early as 20 wks
        
        NOT RECOMMENDED before variability
        
        GBS prophylaxis
        
        Corticosteroids
        
        Tocolysis
        
        Magnesium sulfate for neuroprotection
  - - - PROM (Premature ruptured of mb): rupture of mb before onset of labor
      - PPROM (Preterm PROM): Rupture of mb before labor and before 37 wks of gestation
- - - - Maternal leukocytosis
      - Purulent cervical D/C
      - Fetal tachycardia
  - - - Ampicillin 2 g IV q 6 hrs + Gentamicin 2 mg/kg IV load followed by 1.5 mg/kg q 8 hrs OR Gentamicin 5 mg/kg IV q 24 hrs
      - If allergy to penicillin
        
        Clindamycin/Vancomycin + Gentamicin
        
        Doses
        
        Clindamycin 900 mg IV q 8 hrs
        
        Vancomycin 1 g IV q 12 hrs
        
        Gentamicin same dose as non allergic