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Premature Rupture Of Membranes

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PREMATURE RUPTURE OF MEMBRANES

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Premature Rupture Of Membranes

  1. 1. IN THE NAME OF GOD<br />
  2. 2. Premature rupture of membranes<br />
  3. 3. definition<br />PROM is defined as the rupture of the chorioamniotic membrane before the onset of labor(uterine contractions)<br />
  4. 4. PPROM<br />PROM before gestational age of 37 week <br />Latent phase :<br /> the priod between rupture of membranes and beginning of uterine contractions<br />
  5. 5. incidence<br />5-10 % of all term pregnancyPROM in<br /> 70% of all PROM begin in term pregnancies<br />PPROM in 1% of all pregnancies<br />PROM is acclerator of 1/3 of preterm pregnancies<br />In pt with history of PPROM the incidence of recurrence is 32%<br />
  6. 6. etiology<br />Unknown<br />In PROM may be weakness of physiologic membranes<br />Some of sub clinical infections may play a role<br />
  7. 7. Risk factors<br />1.cervical insufficiency: less than 25mm in 23 week<br />2.polyhydramnious<br />3.history of pprom<br />4.promfibronectin positive in week of <br />23<br />
  8. 8. 1.sub clinical infection: maybe one reason for prom , the relatinship between bacterial vaginosis and pre term labor or pprom show <br />this fact<br />2. (+) culture of amniotic fluid seen in 30% of of pprom3.recent inter course doesn’t have a role in PROM4.cigarette and vaginal bleeding in third of three minester is associated with PROM5. acute iflammation of placenta is seen in most cases of PROM<br />
  9. 9. conclusions of PROM :1. labor begins 24 hours after term PPROMin 80 – 90 % of cases2. tocolytic drugs : not useful , they must be less than 48 hourcomplications :1. RDS2.hypoplasia of lung3.placenta detachment<br />
  10. 10. *EVALUATION :A. diagnosis:1.history2.p/e : sterile spaculume , nitrazine test, ferning test, 3. sonography : oligohydramnious4. fetal fibronectin5. dye injection <br />
  11. 11.
  12. 12. condition of cervix :A. with sterile spaculumeB. trans vaginal sonography: no risk factor for infection in pprom<br />
  13. 13. InfectionA. ifPPROMis diagnosed : recto vaginal culture for GBS ,appropriate AB till coming culture B. chorioamnioutitis : in PPROM , tachycardia of mother and fetus , uterine tenderness, malodor pussy d/c <br />
  14. 14. Infection C. subclinical infection : assopciated with cerebral pulsy, amniocentesis(gram . Glucose .culture) , il-6 , biophysical profile <br />
  15. 15. Treatment :1. steroid befor delivery2. steriod in PPROM3.steroid in less than 28 wk without chorioamnioutits4.exam with finger in chorioamnioutits5.AB prophylaxis<br />
  16. 16. Maturation of lung :1. PG2. L/S<br />
  17. 17. TREATMENT<br />
  18. 18. Management of Premature Rupture of Membranes Chronologically<br />Gestational Age Management<br />Term (37 weeks or more)<br />Near term (34 weeks to 36 completed<br />weeks) :<br />• Proceed to delivery, usually by induction of labor<br />• Group B streptococcal prophylaxis recommended<br />• Same as for term<br />
  19. 19. Preterm (32 weeks to 33 completed<br />weeks) :<br />• Expectant management, unless fetal pulmonary<br />maturity is documented<br />• Group B streptococcal prophylaxis recommended<br />• Corticosteroids—no consensus, but some<br />experts recommend<br />• Antibiotics recommended to prolong latency if<br />there are no contraindications<br />
  20. 20. Preterm (24 weeks to 31 completed<br />weeks) :<br />• Expectant management<br />• Group B streptococcal prophylaxis recommended<br />• Single-course corticosteroid use recommended<br />• Tocolytics—no consensus<br />• Antibiotics recommended to prolong latency if<br />there are no contraindications<br />
  21. 21. Less than 24 weeks: <br />• Expectant Management or induction of labor<br />• Group B streptococcal prophylaxis is not<br />recommended<br />• Corticosteroids are not recommended<br />• Antibiotics—there are incomplete data on use in<br />prolonging latency<br />
  22. 22. THE END<br />BY :<br />HAMZEH<br />HASHEMI<br />

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