Preterm Premature Rupture of the Membranes
By Dr. maysoon sharief
Definition
Rupture of the fetal membranes prior to the completion of the 37th week of pregnancy
Complicates 1/3 of all preterm deliveries
Around 1-2% of pregnancies
Majority of patients delivery within 1 week
ETIOLOGY AND PATHOGENESIS
1-polyhydramnios 2-multiple pregnancy
3- cervical incompetence
4-ascending genital infection
DIAGNOSIS
1-visualization of amniotic fluid in the vagina
2-nitrazine test :PH is normally 4.5-5.5, amniotic fluid has a PH of 7 to 7.5 the paper change to blue in alkaline PH
3- fern test
5-evaporation test
6-ultrasound examination
7-intaamniotic fluorescein
8-amnioscopy
9-fetal fibronectin
10-alfa-fetoprotien test
Matrenal and fetal complication
1-chorioamniotic infection 4.2%- 10.5%
DIAGNOSIS: fever,matrenal tachycardia,fetal tachycardia,uterine tenderness, foul odor of amniotic fluid,matrenal leukocytosis
lab test:WBC,C-reactive protin,Gram stain of amniotic fluid ,most causative organism is group B steptococci,E.coli,ureaplasma urealyticum,mycoplasma hominis, leukocyte esterase assay
2-Hyaline membrane disease
3-pulmonary hypoplasia
4-abruptio placentae
5-fetal distress
6-fetal deformities
MANAGEMENT
Identificaton of patient who require delivery
1-patient in labour
2-patient with mature fetal lung
3-patient with fetal malformation
4- patient with fetal distress
5- patient with overt infection
In all those patients should be deliver regardless of gestational age
EXPECTANT MANAGEMENT
Management
Expectatent
1- bed rest
2- daily checking of Temp.,Bp, pulse rate, uterine contraction, offensive vaginal discharge
3-prophylactic antibiotics
4-tocolytic agent
5-corticosteroid like dexamethasone 8mg\12 hs for 48hs
6-termination of pregnancy at any time infection take place
Management
Frank discussion with parents with mid-trimester PPROM
Some studies suggest that these patients do well if there is some fluid and pregnancy can be prolonged until after 26 weeks
Expectant management is permissible as long as there are no contraindications
