Скачать или смотреть Prelabor rupture of membranes

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The definition of prelabor rupture of membranes is rupture of membranes before the onset of labor. Membrane rupture before labor that occurs before 37 weeks of gestation is referred to as “preterm prelabor rupture of membranes.” Management of preterm and term PROM is influenced by gestational age and the presence of complicating factors such as clinical infection, abruptio placentae, labor, or abnormal fetal testing. An accurate assessment of gestational age and knowledge of the maternal, fetal, and neonatal risks are essential to appropriate evaluation, counseling, and care of patients with PROM.

Membrane rupture may occur for a variety of reasons. Although membrane rupture at term can result from a normal physiologic weakening of the membranes combined with shearing forces created by uterine contractions, preterm PROM can result from a wide array of pathologic mechanisms that act individually or in concert.

Most cases of PROM can be diagnosed on the basis of the patient's history and physical examination. Examination should be performed in a manner that minimizes the risk of introducing infection. Because digital cervical examinations increase the risk of infection and add little information to results available with speculum examination, they generally should be avoided unless the patient appears to be in active labor or delivery seems imminent. Sterile speculum examination provides an opportunity to inspect for cervicitis and prolapse of the umbilical cord or fetal parts, assess cervical dilatation and effacement, and obtain cultures as appropriate.

In all patients with PROM, gestational age, fetal presentation, and fetal well-being should be determined. The examination should evaluate for evidence of intrauterine infection and abruptio placentae. If results are not already available and if an indication for treatment is not already present, culture for group B streptococci (GBS) should be obtained when expectant management is being considered.

#prom #pprom #ruptureofmembranes #amnioticfluid #labor #laboranddelivery #birth #childbirth

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I am a double board certified ObGyn and Maternal-Fetal Medicine specialist focusing on the care of people with maternal and/or fetal complications of pregnancy. I discuss hot topics related to fertility, pregnancy and the postpartum period, and do a little myth-busting and fact-checking to keep things real! Not only am I a doc, but I was also a patient who had infertility, a high-risk twin pregnancy and preterm delivery, and NICU stay at age 43 as a first-time mom--so I GET IT! Leave requests for new topics in comments!
 
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