PREMATURE RUPTURE OF MEMBRANES

1. IN THE NAME OF GOD

2. Premature rupture of membranes

3. definition PROM is defined as the rupture of the chorioamniotic membrane before the onset of labor(uterine contractions)

4. PPROM PROM before gestational age of 37 week Latent phase : the priod between rupture of membranes and beginning of uterine contractions

5. incidence 5-10 % of all term pregnancyPROM in 70% of all PROM begin in term pregnancies PPROM in 1% of all pregnancies PROM is acclerator of 1/3 of preterm pregnancies In pt with history of PPROM the incidence of recurrence is 32%

6. etiology Unknown In PROM may be weakness of physiologic membranes Some of sub clinical infections may play a role

7. Risk factors 1.cervical insufficiency: less than 25mm in 23 week 2.polyhydramnious 3.history of pprom 4.promfibronectin positive in week of 23

8. 1.sub clinical infection: maybe one reason for prom , the relatinship between bacterial vaginosis and pre term labor or pprom show this fact 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

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

10. *EVALUATION :A. diagnosis:1.history2.p/e : sterile spaculume , nitrazine test, ferning test, 3. sonography : oligohydramnious4. fetal fibronectin5. dye injection

12. condition of cervix :A. with sterile spaculumeB. trans vaginal sonography: no risk factor for infection in pprom

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

14. Infection C. subclinical infection : assopciated with cerebral pulsy, amniocentesis(gram . Glucose .culture) , il-6 , biophysical profile

15. Treatment :1. steroid befor delivery2. steriod in PPROM3.steroid in less than 28 wk without chorioamnioutits4.exam with finger in chorioamnioutits5.AB prophylaxis

16. Maturation of lung :1. PG2. L/S

17. TREATMENT

18. Management of Premature Rupture of Membranes Chronologically Gestational Age Management Term (37 weeks or more) Near term (34 weeks to 36 completed weeks) : • Proceed to delivery, usually by induction of labor • Group B streptococcal prophylaxis recommended • Same as for term

19. Preterm (32 weeks to 33 completed weeks) : • Expectant management, unless fetal pulmonary maturity is documented • Group B streptococcal prophylaxis recommended • Corticosteroids—no consensus, but some experts recommend • Antibiotics recommended to prolong latency if there are no contraindications

20. Preterm (24 weeks to 31 completed weeks) : • Expectant management • Group B streptococcal prophylaxis recommended • Single-course corticosteroid use recommended • Tocolytics—no consensus • Antibiotics recommended to prolong latency if there are no contraindications

21. Less than 24 weeks: • Expectant Management or induction of labor • Group B streptococcal prophylaxis is not recommended • Corticosteroids are not recommended • Antibiotics—there are incomplete data on use in prolonging latency

22. THE END BY : HAMZEH HASHEMI