Premature rupture of the membranes <ul><li>General hospital of Tianjin medical university </li></ul><ul><li>Zhang Xuhong <...
Definitions  <ul><li>PROM  is defined as amniorrhexis prior to the onset of labor at any stage of gestation. </li></ul><ul...
Etiology and risk factors <ul><li>Vaginal and cervical infections </li></ul><ul><li>Abnormal membrane physiology </li></ul...
Diagnosis   <ul><li>It is based on the history of vaginal loss of fluid and confirmation of amniotic fluid in the vaginal ...
Confirmation of the diagnosis can be made by: <ul><li>Testing the fluid with nitrazine paper, which will turn blue in the ...
Management  <ul><li>General considerations </li></ul><ul><li>Conservitive expectant management </li></ul><ul><li>Managemen...
General considerations <ul><li>Membranes are a natural barrier to prevent infections </li></ul><ul><li>PPROM has high risk...
Diagnosis of oligohydramnios <ul><li>Ultrasonic definition has been standadized </li></ul><ul><li>Criteria include: </li><...
Oligohydramnios results in: <ul><li>Fetal crowding with thoracic compression </li></ul><ul><li>Restriction of fetal breath...
If PROM occurs at  36  weeks or later, condition of the cervix is favorable,no spontaneous contractions, labor should be i...
Laboratory tests <ul><li>Complete blood cells </li></ul><ul><li>Gram stain and culture of amniotic fluid </li></ul><ul><li...
Conservative expectant management <ul><li>The goal is to continue the pregnancy until the lung profile is mature </li></ul...
Clinical signs and symptoms of chorioamnionitis <ul><li>Maternal temperature is greater than  100.4 0 F  (38 0 C) </li></u...
Management of chorioamnionitis <ul><li>Use antibiotics depends on cultures and sensitivity </li></ul><ul><li>Once antibiot...
<ul><li>Tocolytic therapy </li></ul><ul><li>Use of corticosteriods </li></ul><ul><li>Labor and delivery </li></ul><ul><li>...
Tests of pulmonary maturity <ul><li>Lecithin/sphingomyelin(L/S) ratio  </li></ul><ul><li>maturity >2 </li></ul><ul><li>Lam...
Surfactant therapy <ul><li>It is effective in animal tests </li></ul><ul><li>Only on human trials </li></ul>
 
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10.Preterm Rupture Of The Membranes

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10.Preterm Rupture Of The Membranes

  1. 1. Premature rupture of the membranes <ul><li>General hospital of Tianjin medical university </li></ul><ul><li>Zhang Xuhong </li></ul>
  2. 2. Definitions <ul><li>PROM is defined as amniorrhexis prior to the onset of labor at any stage of gestation. </li></ul><ul><li>Amniorrhexis means spontaneous rupture of membranes as opposed to amniotomy. </li></ul><ul><li>PPROM is used to defined that the patient who are preterm with ruptured membranes, whether or not they have contractions. </li></ul>
  3. 3. Etiology and risk factors <ul><li>Vaginal and cervical infections </li></ul><ul><li>Abnormal membrane physiology </li></ul><ul><li>Incompetent cervix </li></ul><ul><li>Nutritional deficiencies </li></ul>
  4. 4. Diagnosis <ul><li>It is based on the history of vaginal loss of fluid and confirmation of amniotic fluid in the vaginal </li></ul><ul><li>A sterile vaginal speculum examination should be performed </li></ul><ul><li>Before labor, vaginal examination should not be performed </li></ul><ul><li>Carry out a complete ultrasonic examination </li></ul>
  5. 5. Confirmation of the diagnosis can be made by: <ul><li>Testing the fluid with nitrazine paper, which will turn blue in the presence of the alkaline amniotic fluid </li></ul><ul><li>Placing a sample on a microscopic slide, air drying, and examining for ferning </li></ul>
  6. 6. Management <ul><li>General considerations </li></ul><ul><li>Conservitive expectant management </li></ul><ul><li>Management of chorioamnionitis </li></ul><ul><li>Tests of pulmonary maturity </li></ul>
  7. 7. General considerations <ul><li>Membranes are a natural barrier to prevent infections </li></ul><ul><li>PPROM has high risks of infections and sepsus </li></ul><ul><li>PPROM can lead to oligohydramnios </li></ul>
  8. 8. Diagnosis of oligohydramnios <ul><li>Ultrasonic definition has been standadized </li></ul><ul><li>Criteria include: </li></ul><ul><li>(1) measure the amniotic fluid present in 4 quadrands by vertical axis </li></ul><ul><li>(2) AFI: total being called the amniotic fluid index </li></ul><ul><li>(3) A value of less than 5 cm is considered abnormal </li></ul>
  9. 9. Oligohydramnios results in: <ul><li>Fetal crowding with thoracic compression </li></ul><ul><li>Restriction of fetal breathing </li></ul><ul><li>Disturbances of pulmonary fluid production and flow </li></ul><ul><li>Constaints placed on fetal movements in utero can also result in positional skeletal abnomalities, such as talipes equinovarus </li></ul>
  10. 10. If PROM occurs at 36 weeks or later, condition of the cervix is favorable,no spontaneous contractions, labor should be induced after 6-12 hours . <ul><li>If PROM occurs prior to 36 weeks’ gestation, we should manage as followings: </li></ul>
  11. 11. Laboratory tests <ul><li>Complete blood cells </li></ul><ul><li>Gram stain and culture of amniotic fluid </li></ul><ul><li>Pulmonary maturation studies of amniotic fluid </li></ul>
  12. 12. Conservative expectant management <ul><li>The goal is to continue the pregnancy until the lung profile is mature </li></ul><ul><li>Take careful surveillance to diagnose subclinical infection and chorioamnionitis </li></ul>
  13. 13. Clinical signs and symptoms of chorioamnionitis <ul><li>Maternal temperature is greater than 100.4 0 F (38 0 C) </li></ul><ul><li>Fetal tachycardia </li></ul><ul><li>A tender uterus </li></ul><ul><li>Uterine irritability on nonstress testing </li></ul><ul><li>White blood cells elevates </li></ul><ul><li>Measure the amniotic fluid by ultranography </li></ul>
  14. 14. Management of chorioamnionitis <ul><li>Use antibiotics depends on cultures and sensitivity </li></ul><ul><li>Once antibiotics have been started, labor should be induced </li></ul><ul><li>Vaginal delivery or cesarean section </li></ul>
  15. 15. <ul><li>Tocolytic therapy </li></ul><ul><li>Use of corticosteriods </li></ul><ul><li>Labor and delivery </li></ul><ul><li>They are just the same with preterm labor </li></ul>
  16. 16. Tests of pulmonary maturity <ul><li>Lecithin/sphingomyelin(L/S) ratio </li></ul><ul><li>maturity >2 </li></ul><ul><li>Lamellar body number density(LBND) </li></ul><ul><li>maturity>46000  L LBND </li></ul>
  17. 17. Surfactant therapy <ul><li>It is effective in animal tests </li></ul><ul><li>Only on human trials </li></ul>
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