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Prelabor rupture of membranes (PROM) - Coggle Diagram
Prelabor rupture of membranes (PROM)
What is it?
It is the rupture of membranes before the onset of labor. If it occurs before week 37 --> preterm pre labor rupture of membranes
What's its etiology?
Term PROM etiologies:
Normal physiologic weakening of the membranes + shearing forces created by uterine contractions
Preterm pre labor rupture of membranes etiologies:
Intraamniotic infection: specially at earlier gestational ages
Risk factors
For preterm PROM
Previous preterm PROM
Short cervical length
2nd trimester and 3rd trimester bleeding
Low BMI
Low socioeconomic status
Cigarette smoking and illicit drug use
Complications
Of term PROM
Intrauterine infection: increases with the duration of membrane rupture
Of preterm PROM
Intraamniotic infection
Postpartum infection
Abruptio placentae
Complications for the fetus: prematurity
Respiratory distress: greater before 24weeks. Pulmonary hypoplasia depends on gestational age and residual amniotic fluid
Sepsis
Intraventicular hemorrhage
Necrotixing enterocolitis
Neurodevelopmental impairment, white matter damage
Prolonged oligohydramnios: fetal deformations (Potter sequence), limb contractures
Of periviable PROM
Intraamniotic infection
Endometritis
Abruptio placentae
Retained placenta
Sepsis
Hemorrhage with need of transfusion
ARI
Sepsis
Periviable PROM
The probability of neonatal death and morbidity associated with PROM decreases with longer latency and advancing gestational age
Diagnosis
History + physical examination
Sterile speculum examination: inspect for cervicitis and prolapse of the umbilical cord or fetal parts, assess cervical dilation and effacement, and obtain cultures as appropriate
Confirmed by: visualization of amniotic fluid passing from the cervical canal and pooling in the vagina, a pH test for vaginal fluid
USG: examination of amniotic fluid volume
Fetal fibronectin
Treatment
Initial considerations
Assess for gestational age, fetal presentation, fetal well being
Evaluate for evidence of intrauterine infection and abrupt placentae
Culture for group B streptococci
Initial period of electronic fetal heart rate monitoring and uterine activity monitoring
At term PROM
Induction of labor: with vaginal prostaglandins or oxytocin. Cesarean.
Preterm PROM
If: abnormal results from fetal testing, clinical intraamniotic infection and significant abrupt placentae --> delivery
If >34weeks --> expectant: antibiotics + single course corticosteroids + magnesium sulfate for neuroprotection
If >34weeks: deliver + single course steroids
Periviable PROM
Expectant or induction + antibiotics