This document provides guidelines for the assessment and management of preterm premature rupture of membranes (PPROM) at the Royal Hospital for Women. It outlines the optimal outcomes which include timely diagnosis of PPROM, administration of antenatal corticosteroids between 24-34 weeks gestation, and individualized counseling. The guidelines describe the evaluation and management of PPROM based on gestational age, including admission, monitoring, antibiotics, timing of delivery, and counseling regarding maternal and neonatal risks. The goals are to prevent maternal and fetal complications of chorioamnionitis and improve neonatal outcomes.
1. Preterm premature rupture of membranes (PPROM) is the rupture of membranes before 37 weeks of gestation. Antibiotics and corticosteroids should be administered between 24-34 weeks to prolong the latent period, improve outcomes, and decrease risks of complications.
2. Diagnosis of PPROM involves checking the pH and slides of amniotic fluid for signs of rupture. Ultrasound can also assess fluid levels. Expectant management is recommended and includes antibiotics, corticosteroids, and monitoring for infection or other complications.
3. Risk factors for peripartum hysterectomy include placenta accreta with prior c-section, uterine atony, or uterine rupture which
Dr. Kirtan Vyas is an assistant professor who has numerous qualifications and accomplishments. He has published in international journals, presented at conferences, and held various organizational roles. The document discusses preterm labor (PTL), defining it as labor before 37 weeks of pregnancy. It outlines the significance and risk factors of PTL and describes the initial evaluation, management, and potential neonatal complications of PTL. Evaluation includes examination, ultrasound, and biochemical markers to assess the status of the cervix and predict the likelihood of preterm delivery."
PPROM refers to rupture of membranes before 37 weeks of pregnancy, while PROM occurs at or after 37 weeks but before the onset of labor. PPROM and PROM are associated with risks like cord prolapse, maternal and neonatal infection, and 40% of preterm deliveries. Diagnosis involves history of fluid leakage and examination finding a smaller uterus and pooling of fluid in the vagina. Management of PPROM includes antibiotics and steroids to reduce infection rates while PROM may allow labor or require induction depending on presence of meconium. Chorioamnionitis is a maternal infection following rupture that requires delivery and IV antibiotics.
Premature rupture of membranes (PROM) refers to rupture of membranes before the onset of labor. It can occur preterm (before 37 weeks) or term. Risk factors include infections, cervical issues, obesity, and smoking. Diagnosis involves tests like nitrazine paper, fern test, fetal fibronectin, and ultrasound. Management depends on gestational age, infection risk, and fetal status. It may involve antibiotics, corticosteroids, tocolytics, and expectant monitoring or delivery. The goal is to prolong pregnancy when possible to improve neonatal outcomes.
Preterm labor is defined as the onset of labor between 20 weeks of gestation and 37 weeks. Risk factors include a previous preterm birth, low socioeconomic status, infections, and short cervical length. Diagnosis involves assessing for contractions and cervical changes. Treatment aims to delay delivery through tocolysis, corticosteroids to aid lung maturation, antibiotics for infections, and magnesium sulfate for neuroprotection. Progesterone supplementation and cerclage placement can help prevent preterm birth in high risk women. The goal is to prolong pregnancy and improve neonatal outcomes.
This document provides information on preterm labour and preterm premature rupture of membranes (PPROM). It defines preterm labour as onset of labour before 37 weeks of gestation. Risk factors for preterm labour include infections, cervical weakness, smoking, and a history of prior preterm births. Diagnosis involves documenting uterine contractions and assessing cervical changes. Tocolytics can be used to delay labour up to 72 hours to allow for steroid administration. Management may include antibiotics, monitoring, and planning for neonatal intensive care. PPROM is defined as rupture of membranes before 37 weeks and contributes to one third of preterm births.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
1. Preterm premature rupture of membranes (PPROM) is the rupture of membranes before 37 weeks of gestation. Antibiotics and corticosteroids should be administered between 24-34 weeks to prolong the latent period, improve outcomes, and decrease risks of complications.
2. Diagnosis of PPROM involves checking the pH and slides of amniotic fluid for signs of rupture. Ultrasound can also assess fluid levels. Expectant management is recommended and includes antibiotics, corticosteroids, and monitoring for infection or other complications.
3. Risk factors for peripartum hysterectomy include placenta accreta with prior c-section, uterine atony, or uterine rupture which
Dr. Kirtan Vyas is an assistant professor who has numerous qualifications and accomplishments. He has published in international journals, presented at conferences, and held various organizational roles. The document discusses preterm labor (PTL), defining it as labor before 37 weeks of pregnancy. It outlines the significance and risk factors of PTL and describes the initial evaluation, management, and potential neonatal complications of PTL. Evaluation includes examination, ultrasound, and biochemical markers to assess the status of the cervix and predict the likelihood of preterm delivery."
PPROM refers to rupture of membranes before 37 weeks of pregnancy, while PROM occurs at or after 37 weeks but before the onset of labor. PPROM and PROM are associated with risks like cord prolapse, maternal and neonatal infection, and 40% of preterm deliveries. Diagnosis involves history of fluid leakage and examination finding a smaller uterus and pooling of fluid in the vagina. Management of PPROM includes antibiotics and steroids to reduce infection rates while PROM may allow labor or require induction depending on presence of meconium. Chorioamnionitis is a maternal infection following rupture that requires delivery and IV antibiotics.
Premature rupture of membranes (PROM) refers to rupture of membranes before the onset of labor. It can occur preterm (before 37 weeks) or term. Risk factors include infections, cervical issues, obesity, and smoking. Diagnosis involves tests like nitrazine paper, fern test, fetal fibronectin, and ultrasound. Management depends on gestational age, infection risk, and fetal status. It may involve antibiotics, corticosteroids, tocolytics, and expectant monitoring or delivery. The goal is to prolong pregnancy when possible to improve neonatal outcomes.
Preterm labor is defined as the onset of labor between 20 weeks of gestation and 37 weeks. Risk factors include a previous preterm birth, low socioeconomic status, infections, and short cervical length. Diagnosis involves assessing for contractions and cervical changes. Treatment aims to delay delivery through tocolysis, corticosteroids to aid lung maturation, antibiotics for infections, and magnesium sulfate for neuroprotection. Progesterone supplementation and cerclage placement can help prevent preterm birth in high risk women. The goal is to prolong pregnancy and improve neonatal outcomes.
This document provides information on preterm labour and preterm premature rupture of membranes (PPROM). It defines preterm labour as onset of labour before 37 weeks of gestation. Risk factors for preterm labour include infections, cervical weakness, smoking, and a history of prior preterm births. Diagnosis involves documenting uterine contractions and assessing cervical changes. Tocolytics can be used to delay labour up to 72 hours to allow for steroid administration. Management may include antibiotics, monitoring, and planning for neonatal intensive care. PPROM is defined as rupture of membranes before 37 weeks and contributes to one third of preterm births.
This document summarizes a presentation given by Dr. Rajni Singh on vaginal hysterectomy techniques. Key points include:
- Vaginal hysterectomy is the safest and most cost-effective surgical route for conditions like fibroids and abnormal bleeding, with less complications and faster recovery compared to abdominal hysterectomy.
- Evaluation of pelvic support and anatomy is important prior to the surgery.
- Techniques like bladder dissection, use of curved scissors and hemostatic systems like Ligasure can aid in performing a bloodless procedure.
- Post-operative care includes catheter removal after 12 hours and discharge usually within 24-36 hours. Potential complications include vault hematoma, infections and urinary tract injuries
The document discusses preterm labour and provides information on its definition, incidence, neonatal outcomes, aetiology, risk factors, and management approaches. It defines preterm labour as deliveries occurring between 24 and 36 weeks of gestation. It notes the condition is a leading cause of newborn deaths worldwide and can cause neurological impairments and disabilities in surviving infants. The document outlines various risk factors and approaches to managing asymptomatic high-risk women, including screening, prevention methods, and lifestyle modifications. It also discusses evaluating and treating symptomatic women, including assessing maternal and fetal status, administering corticosteroids and tocolytics, providing antibiotics if indicated, and considering emergency cerclage or in utero transfer.
The document discusses the induction and augmentation of labor. It defines labor as the series of events that result in the expulsion of the fetus from the uterus through the vagina. Induction of labor is defined as initiating uterine contractions for vaginal delivery through medical, surgical, or combined methods after viability. Augmentation refers to stimulating already present but inadequate uterine contractions. The document also mentions elective induction of labor for convenience without a medical reason.
Keith Moore Said "It has been a great pleasure for me to help clarify statements in the Qur'an about human development. It is clear to me that these statements must have come to Muhammad from God, or Allah, because most of this knowledge was not discovered until many centuries later. This proves to me that Muhammad must have been a messenger of God, or Allah."
This document discusses preterm prelabour rupture of membranes (PPROM), which complicates 2% of pregnancies but is associated with 40% of preterm deliveries and can result in neonatal morbidity and mortality. It is diagnosed through maternal history and sterile speculum exam. Ultrasound may help confirm but a normal fluid index does not rule it out. Women should be observed for signs of chorioamnionitis every 4-6 hours. The document outlines antibiotic, corticosteroid and tocolytic treatment and discusses the timing of delivery for managing PPROM.
Preterm labour is defined as the onset of labour before 37 weeks of pregnancy and has an incidence rate of 5-10%. It can be caused by maternal medical disorders like preeclampsia, foetal congenital anomalies, or may have no identifiable cause. Premature infants are at risk for birth trauma like intracranial hemorrhage. They also face risks like respiratory distress syndrome where their underdeveloped lungs lack sufficient surfactant, causing breathing difficulties and potential death. Other risks include hypothermia due to reduced heat production and increased heat loss in underdeveloped preterm infants.
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
This document discusses transverse lie and cord prolapse during labor. It provides information on:
1) The definition and causes of transverse lie, where the fetus lies horizontally across the uterus with the shoulder over the pelvic inlet.
2) The diagnosis of transverse lie which involves abdominal and vaginal examinations to identify fetal parts and position. Ultrasound can also confirm the diagnosis.
3) The risks of transverse lie including cord prolapse, obstructed labor, and fetal death. Management involves external cephalic version or cesarean section.
4) The definition, causes, diagnosis, and management of cord prolapse, which requires immediate delivery by cesarean section if the fetus is alive or
This document discusses antenatal corticosteroids, which are steroids administered to women at risk of preterm birth to accelerate fetal lung maturation. Antenatal corticosteroids are associated with significant reductions in neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, and other complications. They are generally recommended for women between 24-34 weeks gestation at risk of preterm birth. A single course is considered safe for the mother and fetus, while multiple courses require more research on long-term effects. The optimal dosage is 12mg of betamethasone administered intramuscularly in two doses.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses preterm birth and preterm premature rupture of membranes (PPROM). It defines preterm birth as delivery before 37 weeks of gestation and notes that the rate of spontaneous preterm births is decreasing while induced preterm births are rising. PPROM is defined as rupture of membranes before 37 weeks, and risk factors, diagnosis, and management approaches are outlined. Expectant management is generally recommended for PPROM between 24-34 weeks to balance infection and prematurity risks.
The document discusses preterm labor and birth. It defines preterm birth as babies born alive before 37 weeks of pregnancy. It notes the main complications of preterm birth include neonatal death, respiratory distress syndrome, and other issues. Risk factors for preterm birth include multiple pregnancies, smoking, cervical insufficiency, and infection. The prevention and treatment of preterm labor focuses on identifying women at risk and using interventions like progesterone supplementation, cervical cerclage, and tocolytic drugs to delay birth.
Preterm labour is defined as onset of labour between the gestation of viability (24 weeks) and 37 completed weeks. The majority of preterm births occur between 32-37 weeks (late preterm). Risk factors include low socioeconomic status, maternal age, smoking, infection and previous preterm birth history. Screening methods include cervical length screening by ultrasound and fetal fibronectin testing. Management includes progesterone supplementation for women with a short cervix, cervical cerclage for those with a history of prior preterm birth, and corticosteroid administration to accelerate fetal lung maturity. While tocolytic drugs may temporarily stop contractions, there is no evidence they improve neonatal outcomes.
1. Bleeding in early pregnancy can be caused by miscarriage, ectopic pregnancy, or rare conditions like cervical cancer or polyps.
2. Miscarriage is the most common cause, and it is defined as the natural or spontaneous end of a pregnancy before 24 weeks. Early pregnancy assessment using transvaginal ultrasound and serum hCG levels can help diagnose the cause.
3. Ectopic pregnancies, which occur when a fertilized egg implants outside the uterus, should also be considered and ruled out as they can be life-threatening if ruptured. Transvaginal ultrasound and serial hCG measurements are used to diagnose ectopic pregnancies.
1) The use of tocolytic drugs is associated with prolonging pregnancy up to 7 days but does not significantly impact preterm birth rates or neonatal outcomes.
2) Tocolysis should only be considered if delaying birth will allow for completing a course of corticosteroids or in utero transfer to another hospital.
3) Nifedipine and atosiban are effective tocolytic options, with fewer maternal side effects than beta-agonists, though long-term neonatal outcomes remain unclear for all tocolytic drugs.
Induction of labour involves initiating uterine contractions before spontaneous onset using methods like cervical ripening, amniotomy, or pharmacological agents. The cervix status and fetal well-being must be assessed first, and induction contraindicated for issues like placenta previa or active herpes. Common ripening agents include prostaglandins like misoprostol or dinoprostone administered vaginally, and oxytocin is often used after amniotomy to induce contractions. Complications of each method and guidelines for special circumstances are outlined.
Preterm labor is defined as labor beginning before 37 weeks of gestation. It occurs in 7-12% of pregnancies worldwide and is a major cause of neonatal mortality and morbidity. Risk factors include infections, uterine distention from multiples, short cervical length on ultrasound, prior preterm births, and short inter-pregnancy intervals. Diagnosis involves assessing cervical dilation and effacement on exam along with fetal fibronectin testing and ultrasound evaluation of the cervix. Management aims to delay delivery as long as possible to improve neonatal outcomes.
This document provides information on operative hysteroscopy, including prerequisites, contraindications, instrumentation, anaesthesia, distension media, indications, and techniques for various procedures like endometrial ablation, uterine septum resection, myomectomy, and adhesiolysis. It discusses the advantages and disadvantages of hysteroscopic morcellators. Complications of hysteroscopic myomectomy and post-operative care are also outlined. Various classifications for submucous fibroids and intrauterine adhesions are presented.
Mdm. JT, a 40+9 week primigravida, presented with leaking liquor for 6 hours and irregular tightening for 2 hours. She was diagnosed with Group B Streptococcus (GBS) at 12 weeks via routine vaginal swab. She received antibiotics as prophylaxis. On examination, she had an open os at 2cm. She was started on IV penicillin as GBS prophylaxis and later delivered via emergency c-section for arrest of labor. Her baby was admitted to the nursery for presumed sepsis due to maternal GBS status. The document then discusses GBS screening recommendations, treatment guidelines, and outcomes based on the ORACLE studies.
The document discusses preterm labour and provides information on its definition, incidence, neonatal outcomes, aetiology, risk factors, and management approaches. It defines preterm labour as deliveries occurring between 24 and 36 weeks of gestation. It notes the condition is a leading cause of newborn deaths worldwide and can cause neurological impairments and disabilities in surviving infants. The document outlines various risk factors and approaches to managing asymptomatic high-risk women, including screening, prevention methods, and lifestyle modifications. It also discusses evaluating and treating symptomatic women, including assessing maternal and fetal status, administering corticosteroids and tocolytics, providing antibiotics if indicated, and considering emergency cerclage or in utero transfer.
The document discusses the induction and augmentation of labor. It defines labor as the series of events that result in the expulsion of the fetus from the uterus through the vagina. Induction of labor is defined as initiating uterine contractions for vaginal delivery through medical, surgical, or combined methods after viability. Augmentation refers to stimulating already present but inadequate uterine contractions. The document also mentions elective induction of labor for convenience without a medical reason.
Keith Moore Said "It has been a great pleasure for me to help clarify statements in the Qur'an about human development. It is clear to me that these statements must have come to Muhammad from God, or Allah, because most of this knowledge was not discovered until many centuries later. This proves to me that Muhammad must have been a messenger of God, or Allah."
This document discusses preterm prelabour rupture of membranes (PPROM), which complicates 2% of pregnancies but is associated with 40% of preterm deliveries and can result in neonatal morbidity and mortality. It is diagnosed through maternal history and sterile speculum exam. Ultrasound may help confirm but a normal fluid index does not rule it out. Women should be observed for signs of chorioamnionitis every 4-6 hours. The document outlines antibiotic, corticosteroid and tocolytic treatment and discusses the timing of delivery for managing PPROM.
Preterm labour is defined as the onset of labour before 37 weeks of pregnancy and has an incidence rate of 5-10%. It can be caused by maternal medical disorders like preeclampsia, foetal congenital anomalies, or may have no identifiable cause. Premature infants are at risk for birth trauma like intracranial hemorrhage. They also face risks like respiratory distress syndrome where their underdeveloped lungs lack sufficient surfactant, causing breathing difficulties and potential death. Other risks include hypothermia due to reduced heat production and increased heat loss in underdeveloped preterm infants.
The document discusses peripartum hysterectomy, including its definition, history, incidence and trends, risk factors, types, indications, complications, and techniques. A key point is that a sequence of conservative measures should be attempted before hysterectomy to control uterine hemorrhage, as indecisiveness can lead to fatal excessive bleeding. The "Triple-P procedure" is also summarized as a three-step conservative approach involving obstetric, anesthesia and interventional radiology teams to prevent hemorrhage and need for hysterectomy in high-risk cases.
This document discusses transverse lie and cord prolapse during labor. It provides information on:
1) The definition and causes of transverse lie, where the fetus lies horizontally across the uterus with the shoulder over the pelvic inlet.
2) The diagnosis of transverse lie which involves abdominal and vaginal examinations to identify fetal parts and position. Ultrasound can also confirm the diagnosis.
3) The risks of transverse lie including cord prolapse, obstructed labor, and fetal death. Management involves external cephalic version or cesarean section.
4) The definition, causes, diagnosis, and management of cord prolapse, which requires immediate delivery by cesarean section if the fetus is alive or
This document discusses antenatal corticosteroids, which are steroids administered to women at risk of preterm birth to accelerate fetal lung maturation. Antenatal corticosteroids are associated with significant reductions in neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, and other complications. They are generally recommended for women between 24-34 weeks gestation at risk of preterm birth. A single course is considered safe for the mother and fetus, while multiple courses require more research on long-term effects. The optimal dosage is 12mg of betamethasone administered intramuscularly in two doses.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This document discusses preterm birth and preterm premature rupture of membranes (PPROM). It defines preterm birth as delivery before 37 weeks of gestation and notes that the rate of spontaneous preterm births is decreasing while induced preterm births are rising. PPROM is defined as rupture of membranes before 37 weeks, and risk factors, diagnosis, and management approaches are outlined. Expectant management is generally recommended for PPROM between 24-34 weeks to balance infection and prematurity risks.
The document discusses preterm labor and birth. It defines preterm birth as babies born alive before 37 weeks of pregnancy. It notes the main complications of preterm birth include neonatal death, respiratory distress syndrome, and other issues. Risk factors for preterm birth include multiple pregnancies, smoking, cervical insufficiency, and infection. The prevention and treatment of preterm labor focuses on identifying women at risk and using interventions like progesterone supplementation, cervical cerclage, and tocolytic drugs to delay birth.
Preterm labour is defined as onset of labour between the gestation of viability (24 weeks) and 37 completed weeks. The majority of preterm births occur between 32-37 weeks (late preterm). Risk factors include low socioeconomic status, maternal age, smoking, infection and previous preterm birth history. Screening methods include cervical length screening by ultrasound and fetal fibronectin testing. Management includes progesterone supplementation for women with a short cervix, cervical cerclage for those with a history of prior preterm birth, and corticosteroid administration to accelerate fetal lung maturity. While tocolytic drugs may temporarily stop contractions, there is no evidence they improve neonatal outcomes.
1. Bleeding in early pregnancy can be caused by miscarriage, ectopic pregnancy, or rare conditions like cervical cancer or polyps.
2. Miscarriage is the most common cause, and it is defined as the natural or spontaneous end of a pregnancy before 24 weeks. Early pregnancy assessment using transvaginal ultrasound and serum hCG levels can help diagnose the cause.
3. Ectopic pregnancies, which occur when a fertilized egg implants outside the uterus, should also be considered and ruled out as they can be life-threatening if ruptured. Transvaginal ultrasound and serial hCG measurements are used to diagnose ectopic pregnancies.
1) The use of tocolytic drugs is associated with prolonging pregnancy up to 7 days but does not significantly impact preterm birth rates or neonatal outcomes.
2) Tocolysis should only be considered if delaying birth will allow for completing a course of corticosteroids or in utero transfer to another hospital.
3) Nifedipine and atosiban are effective tocolytic options, with fewer maternal side effects than beta-agonists, though long-term neonatal outcomes remain unclear for all tocolytic drugs.
Induction of labour involves initiating uterine contractions before spontaneous onset using methods like cervical ripening, amniotomy, or pharmacological agents. The cervix status and fetal well-being must be assessed first, and induction contraindicated for issues like placenta previa or active herpes. Common ripening agents include prostaglandins like misoprostol or dinoprostone administered vaginally, and oxytocin is often used after amniotomy to induce contractions. Complications of each method and guidelines for special circumstances are outlined.
Preterm labor is defined as labor beginning before 37 weeks of gestation. It occurs in 7-12% of pregnancies worldwide and is a major cause of neonatal mortality and morbidity. Risk factors include infections, uterine distention from multiples, short cervical length on ultrasound, prior preterm births, and short inter-pregnancy intervals. Diagnosis involves assessing cervical dilation and effacement on exam along with fetal fibronectin testing and ultrasound evaluation of the cervix. Management aims to delay delivery as long as possible to improve neonatal outcomes.
This document provides information on operative hysteroscopy, including prerequisites, contraindications, instrumentation, anaesthesia, distension media, indications, and techniques for various procedures like endometrial ablation, uterine septum resection, myomectomy, and adhesiolysis. It discusses the advantages and disadvantages of hysteroscopic morcellators. Complications of hysteroscopic myomectomy and post-operative care are also outlined. Various classifications for submucous fibroids and intrauterine adhesions are presented.
Mdm. JT, a 40+9 week primigravida, presented with leaking liquor for 6 hours and irregular tightening for 2 hours. She was diagnosed with Group B Streptococcus (GBS) at 12 weeks via routine vaginal swab. She received antibiotics as prophylaxis. On examination, she had an open os at 2cm. She was started on IV penicillin as GBS prophylaxis and later delivered via emergency c-section for arrest of labor. Her baby was admitted to the nursery for presumed sepsis due to maternal GBS status. The document then discusses GBS screening recommendations, treatment guidelines, and outcomes based on the ORACLE studies.
This document discusses premature rupture of membranes (PROM), defined as rupture of the amniotic sac before the onset of labor. It provides information on the incidence, risk factors, evaluation, and management of PROM depending on gestational age. PROM occurs in 5-10% of term pregnancies and 1% of all pregnancies are preterm premature rupture of membranes (PPROM) before 37 weeks. Risk factors include cervical insufficiency, polyhydramnios, and history of PPROM. Evaluation involves diagnostic tests and examination for infection risk. Management includes expectant care, antibiotics, corticosteroids depending on gestational age to prolong latency and promote lung maturation.
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Pradeep Garg
The document summarizes information on preterm labor and premature rupture of membranes. It defines preterm labor as regular contractions before 37 weeks of gestation that are associated with cervical changes. It notes the incidence of preterm labor is 8-10% and discusses definitions, magnitude, causes, risk factors, signs and symptoms, biological markers, cervical length screening, infections associated with preterm labor, and treatments including tocolytics and antenatal corticosteroids.
Premature Rupture of Membranes (PROM) refers to rupture of membranes before the onset of labor. It occurs in 10% of term pregnancies and more commonly in preterm labor. PROM can be diagnosed through various tests including a nitrazine paper test, fern test, sterile speculum exam, or ultrasound. Complications of PROM include preterm labor, infection, and fetal deformities or distress. Management depends on gestational age - expectant management is common above 34 weeks while induction or C-section may be recommended below 36 weeks to prevent complications.
Premature rupture of the membranes (PROM) is defined as spontaneous rupture of membranes prior to the onset of labor. PROM carries high risks of infection and sepsis and can lead to oligohydramnios. Diagnosis is based on history and testing fluid samples. Management depends on gestational age - if after 36 weeks labor is induced, if earlier conservative management is used to continue the pregnancy while monitoring for infection until the lungs are mature.
PPROM, or preterm premature rupture of membranes, occurs when the amniotic sac ruptures before the 37th week of pregnancy. It leads to 40% of preterm deliveries and is associated with neonatal death from prematurity, sepsis, and pulmonary hypoplasia. Diagnosis involves a sterile speculum exam to check for fluid discharge, ultrasound to check amniotic fluid levels, and microscopic exam of fluid for ferning patterns. Risk factors include trauma, infection, and sexual intercourse. Management includes monitoring maternal and fetal health, administering steroids to accelerate fetal lung maturity, and antibiotics to treat infection.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines PROM as occurring beyond 28 weeks of gestation but before labor, and preterm PROM (PPROM) as occurring between 28-37 weeks.
The document outlines the risk factors, symptoms, diagnosis, and management of PROM depending on gestational age. Evaluation involves history, physical exam including speculum exam, and tests like nitrazine, ferning, fetal fibronectin, and ultrasound. Management often involves expectant monitoring, antibiotics, corticosteroids, and tocolytics to prolong the pregnancy if it is prior to 34 weeks. The goals are
This document discusses premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM), including their definitions, signs and symptoms, diagnostic testing, management, and risks. It provides guidelines for evaluating a patient with PROM or PPROM, testing to confirm rupture using nitrazine and fern tests, expectantly managing or inducing labor depending on gestational age and test results, administering antibiotics and corticosteroids as indicated, and monitoring for infection and fetal well-being. The risks of expectant management include increased rates of chorioamnionitis, cesarean delivery, and respiratory distress in infants.
Preterm prelabour rupture of membranes (P-PROM) NICE guideline November 2015Aboubakr Elnashar
This document provides guidelines for diagnosing and treating preterm prelabour rupture of membranes (P-PROM). It recommends performing a speculum exam to check for pooling of amniotic fluid, and if none is seen, conducting tests of vaginal fluid such as insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1. For treatment, it recommends a course of oral erythromycin or penicillin antibiotics. It also provides guidance on identifying intrauterine infection using a combination of clinical assessment, C-reactive protein, white blood cell count, and cardiotocography.
This document defines and discusses premature rupture of membranes (PROM), which is the rupture of fetal membranes before the onset of labor. It covers the incidence, risk factors, clinical presentation and diagnosis of PROM. The management of term and preterm PROM is also outlined, including maternal and fetal surveillance, use of antibiotics and steroids to promote lung maturity, and criteria for terminating the pregnancy. Preterm birth is a significant health issue due to increased risks of infant mortality and morbidities.
This document discusses prelabor rupture of membranes (PROM), also known as premature rupture of membranes. It defines PROM and discusses frequencies. Consequences of PROM include preterm birth and associated complications like respiratory distress syndrome. It also discusses risks of infection to the mother and baby. Management approaches are provided for term PROM, preterm PROM, and PROM occurring at various gestational ages. Recommendations include expectant management with antibiotics for term PROM and delivery after 24 hours if no signs of infection. Preterm PROM guidelines include corticosteroids, antibiotics, and delivery by 34 weeks if uncomplicated.
Prelabour rupture of membranes (PROM) refers to rupture of membranes before the onset of labour. It can occur preterm (PPROM) or at term (TPROM). Accurate diagnosis is important to determine management. For term PROM, immediate induction with oxytocin is recommended to reduce infection risks. For preterm PROM, antibiotics are given and delivery often occurs soon after due to infection risks for mother and baby. Management depends on gestational age and involves weighing infection risks against benefits of prolonging pregnancy.
Human chorionic gonadotropin (hCG) is a hormone produced during pregnancy. hCG levels rise rapidly in early pregnancy and can indicate multiple pregnancies, Down syndrome, or an ectopic pregnancy if levels are low. Serial hCG measurements are used to monitor pregnancies of unknown location, diagnose failing pregnancies, and guide treatment for gestational trophoblastic diseases like molar pregnancies. Discriminatory hCG levels, doubling times, and international criteria help determine management for these conditions.
This document discusses obesity and a new approach to weight loss using HCG injections. It explains that obesity is a disorder caused by abnormal fat deposits regulated by the brain. The HCG protocol conditions the brain and weakens its control over abnormal fat deposits, allowing for successful weight loss without food restrictions or exercise. More information can be found at www.coachalisa.com.
1) In the mid-19th century, there were major advances in medicine including the first accurate description of the human body by Andreas Vesalius and the introduction of stitches instead of cauterization for wound closure.
2) Anesthesia was introduced, first with ether in 1842, which revolutionized surgery by reducing pain.
3) Dentistry lacked modern techniques like anesthesia, drills and fillings caused extreme pain.
4) Women faced barriers in medicine, with Elizabeth Blackwell becoming the first woman to earn a medical degree in 1849.
The document describes a case of a 30-year-old female patient who was admitted to the hospital due to abruptio placenta and severe preeclampsia. She experienced vaginal bleeding and abdominal pain at 37 weeks and 5 days of gestation. Upon admission, she was found to have high blood pressure of 190/120 mmHg and her baby was in fetal distress. She underwent an emergency c-section but unfortunately her baby was stillborn. Her medical history included a previous pregnancy, hypertension since age 20 that was untreated, and a family history of hypertension and other conditions. She was confined for 14 days following the c-section.
Abruptio placentae is the separation of a normally situated placenta from the uterus after 28 weeks of gestation. It can be revealed, with vaginal bleeding, concealed without bleeding, or mixed. Risk factors include hypertension, trauma, high parity, and premature rupture of membranes. It is graded based on symptoms from mild to severe. Treatment involves resuscitation, monitoring, and either expectant management to prolong pregnancy if mild or immediate delivery if moderate to severe due to risks of hemorrhage, DIC, renal failure, and fetal hypoxia.
This document discusses amniotic fluid disorders including polyhydramnios and oligohydramnios. It defines polyhydramnios as excessive amniotic fluid over 2 liters and oligohydramnios as diminished fluid under 500 ml. Causes, diagnosis, and complications are described for each condition. Polyhydramnios can be caused by fetal abnormalities or diabetes and risks preterm labor and cord problems. Oligohydramnios risks pulmonary hypoplasia and deformities from compression and is often caused by renal issues. Management may include treating underlying issues, monitoring fetal wellbeing, and amnioinfusion.
APH affects 3-5% of pregnancies and is a leading cause of preterm birth. Clinical assessment of APH involves history, examination, and ultrasound to determine the cause and severity of bleeding and risk to the mother and fetus. Management priorities are resuscitation of the mother, monitoring the fetus, restricting activity and delivery depending on gestational age and severity of the condition.
This document discusses premature rupture of membranes (PROM), including definitions of term PROM (rupture at or after 37 weeks) and preterm PROM (rupture before 37 weeks). It provides information on risk factors, diagnosis, management, and treatment recommendations depending on gestational age. For term PROM, induction of labor is usually recommended. For preterm PROM between 24-33 weeks, expectant management with antibiotics is preferred to prolong the pregnancy if possible. Delivery is recommended for preterm PROM at or above 34 weeks.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines term and preterm PROM and discusses the diagnosis, causes, complications, and management of PROM. The key points are:
- PROM is diagnosed based on a history of leakage and physical exam findings like pooling of fluid. Tests like nitrazine and fern tests can also help diagnose.
- Causes of PROM can include infections, smoking, collagen deficiencies, mechanical stress from twins or polyhydramnios.
- Complications include infections, preterm labor and delivery, and respiratory distress in preterm infants.
- Management depends on gestational age,
This document discusses pre-labour rupture of membranes (PROM), specifically defining it as rupture of membranes before the onset of labour. It describes the typical incidence rates of term and preterm PROM. The document then outlines the clinical diagnosis and assessment process, including examination findings and additional tests that can be used. Expectant and active management strategies are described for term and preterm PROM cases. Complications associated with PROM are also summarized.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It is a leading cause of perinatal morbidity and mortality, affecting around 11.1% of births worldwide. Risk factors include low socioeconomic status, age under 18 or over 40, smoking, substance abuse, and previous preterm births. Diagnosis involves pelvic exams, ultrasound, fetal fibronectin testing, and cervical length screening. Management includes bed rest, tocolysis to delay delivery, corticosteroids to promote fetal lung maturity, antibiotics for infections, and magnesium sulfate which has both tocolytic and neuroprotective effects. Outcomes have improved with neonatal intensive care but prematurity remains a major challenge.
(1) Preterm labor is defined as labor beginning before 37 weeks of gestation and is a significant cause of perinatal morbidity and mortality, with an incidence of 5-10%.
(2) Risk factors for preterm labor include previous preterm births, infections, cervical insufficiency, uterine anomalies, and medical/surgical complications of pregnancy. Diagnosis is based on regular contractions and cervical changes seen on examination or ultrasound.
(3) Management involves attempts to arrest preterm labor if it is not too far advanced, such as with bed rest, hydration, antibiotics if infection is present, tocolytic drugs, and corticosteroids to aid fetal lung maturation if delivery is likely
(1) Preterm labor is defined as labor beginning before 37 weeks of gestation and is a significant cause of perinatal morbidity and mortality, with an incidence of 5-10%.
(2) Risk factors for preterm labor include previous preterm births, infections, cervical insufficiency, multiple gestations, and medical/obstetric complications of pregnancy. Diagnosis is based on regular contractions and cervical changes seen on exam or ultrasound.
(3) Management involves attempts to arrest preterm labor if it is not too preterm, including bed rest, hydration, antibiotics if infection is present, tocolytic drugs, and corticosteroids to aid fetal lung maturation if delivery is likely
Preterm labor is defined as labor beginning before 37 weeks of gestation. It can be spontaneous or iatrogenic and is a leading cause of neonatal mortality globally. Diagnosis involves assessing cervical dilation, length, and contractions. Risk factors include prior preterm birth, infection, cervical insufficiency, and multiple gestations. Treatment aims to prolong pregnancy through tocolysis to allow for antenatal corticosteroids and magnesium sulfate administration, which reduce neonatal respiratory and neurological complications respectively. Antibiotics may also be given for GBS prophylaxis or infection treatment. The goal of intervention is to delay birth until a gestational age of viability or transfer to a higher level of care is possible.
Prelabor Rupture of Membranes NICE Guideline 2022 Dr Ahmed Walid-1.pptxAhmed Walid Anwar Morad
Prelabor rupture of membranes (PROM) complicates about 10% of pregnancies. This document discusses definitions, incidence, etiology, pathophysiology, diagnosis, complications, prophylaxis and management of PROM. Key points include that PROM can occur preterm or at term, the importance of accurate diagnosis, and that management depends on gestational age and involves antibiotics, corticosteroids, tocolytics and magnesium sulfate as appropriate to prolong the pregnancy and minimize complications.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
MANAGEMENT OF PRETERM PROM ON INDUCTION OF LABOUR Lifecare Centre
INCIDENCE OF PPROM
Preterm PROM-defined as PROM prior to 37 weeks of gestation complicates
2% to 4% of all singleton
7% to 20% of twin pregnancies.
It is the leading identifiable cause of premature birth ( 30%)
accounts for approximately 18% to 20% of perinatal deaths in the United States.
Dr. Sharda Jain
Dr. jyoti Bhasker
Preterm labour & premature rupture of membranes (IL).pdfElhadi Miskeen
A 34-year-old patient presented at 27 weeks gestation with vaginal bleeding and contractions. She had a prior preterm delivery at 33 weeks. The next steps in evaluation and management are to monitor vital signs and perform a cervical exam to check for change in dilation or effacement. Antenatal steroids and antibiotics would be administered to improve neonatal outcomes if delivery is imminent. Tocolytic therapy may be given to delay delivery if the cervix has not changed and bleeding and contractions subside. The goal of treatment is to prolong the pregnancy as long as possible while preventing infection and complications of prematurity for mother and baby.
Pprom by dr alka mukherjee dr apurva mukherjee nagpur indiaalka mukherjee
Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.
In most cases of PPROM, the cause is not known.
These things may increase risk:
• Having a preterm birth in a previous pregnancy
• Having an infection in your reproductive system
• Vaginal bleeding during pregnancy
• Smoking during pregnancy
Symptoms can occur a bit differently in each pregnancy. They can include:
• A sudden gush of fluid from your vagina
• Leaking of fluid from your vagina
• A feeling of wetness in your vagina or underwear
Call your healthcare provider right away if you have these symptoms.
The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.
Diagnosis
• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.
• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.
• ultrasound exam. This is done to check the amount of amniotic fluid around baby.
Preterm labor is defined as the onset of labor before 37 weeks of gestation. It is a leading cause of neonatal morbidity and mortality, and can lead to long-term health problems for the baby. Risk factors for preterm labor include a history of preterm labor or delivery, multiple gestations, cervical incompetence, uterine anomalies, and infections.
Symptoms of preterm labor can include regular contractions, pelvic pressure or pain, backache, vaginal bleeding or discharge, and a change in vaginal discharge. If preterm labor is suspected, immediate medical attention is required. Treatment may include medications to stop or slow down labor, steroid injections to help speed up fetal lung development, and bed rest.
Prevention of preterm labor can be achieved through good prenatal care, including regular prenatal visits, proper nutrition, and management of underlying medical conditions. Avoiding certain risk factors, such as smoking and substance abuse, can also help reduce the risk of preterm labor.
In cases where preterm labor cannot be prevented, the goal is to delay delivery as long as possible to give the baby the best chance of survival and good health. This may involve hospitalization for bed rest, medication, and close monitoring of the mother and baby.
Preterm labor is a serious and potentially life-threatening complication of pregnancy, but with appropriate management and early intervention, the risk of morbidity and mortality can be minimized.
This document provides an overview of premature rupture of membranes (PRM). It defines PRM as rupture of membranes more than 1 hour before the onset of labor. The document discusses the aetiologies, pathologies, clinical signs, differential diagnosis, paraclinical investigations, complications, and treatment of PRM. It notes that PRM is associated with increased perinatal morbidity and mortality, so prompt diagnosis and management are important. The treatment aims to reduce infection risk and accelerate lung maturity if needed before delivery.
This document provides definitions and information about premature rupture of membranes (PROM). It discusses the incidence, fetal membranes, causes, clinical presentation and diagnosis of PROM. Diagnostic tests mentioned include the nitrazine test, ferning, ultrasound, indigo carmine instillation and AmniSure. Complications of PROM for both mother and fetus are outlined. The document also covers management of term and preterm PROM, including maternal and fetal surveillance, antibiotics, steroids and tocolytics. Preterm birth is discussed in terms of definitions, significance, long-term disabilities, incidence, pathogenesis and clinical manifestations.
Preterm Birth Interventions_James Litch_10.16.13CORE Group
Prevention of Preterm Birth and Complications outlines key definitions, numbers, and interventions related to preterm birth. It begins with defining preterm birth as babies born alive before 37 completed weeks of pregnancy. It then presents a strategic three-phase approach and discusses how preterm birth is connected to other maternal and child health outcomes. The document reviews evidenced-based interventions to manage preterm birth like antenatal corticosteroids and antibiotics for premature prelabor rupture of membranes. It also discusses interventions for caring for preterm newborns and ways to prevent preterm birth like birth spacing and treating infectious diseases.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Preterm premature rupture of membranes (pprom) assessment and management guideline
1. Obstetric Clinical Guidelines Group October 2009
ROYAL HOSPITAL FOR WOMEN
Approved by
Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES
18/2/10
PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) – ASSESSMENT AND
MANAGEMENT GUIDELINE
1. OPTIMAL OUTCOMES
• Timely and accurate diagnosis of PPROM
• Antenatal corticosteroids administered to woman with PPROM occurring between 24 and 34
weeks gestation
• Maternal and fetal sequelae of chorioamnionitis are avoided
• Woman receives individualised counselling regarding management options for PPROM and
expected neonatal outcomes
2. PATIENT
• Pregnant woman with suspected rupture of membranes <37 weeks’ gestation who is not in
labour
3. STAFF
• Medical officers
• Registered midwives
• Student midwives
4. EQUIPMENT
• Sterile speculum
• Liquor detection kit
• Sterile vaginal swab
• Sterile gloves
• Light source
• Cardiotocograph (CTG) machine
5. CLINICAL PRACTICE
Perform midwifery admission
•
• Organise obstetric review
• Take and document history including:
o Gestational age and method for dating of pregnancy
o Date and time of suspected rupture of membranes
o Fluid volume, colour and odour
o Presence of uterine contractions
o Infective symptoms e.g. fever, rigors, dysuria, offensive vaginal discharge, uterine
tenderness
o Group B strep (GBS) status if known
o Fetal lie
o Placental location
• Perform abdominal palpation and determine fetal lie and presentation and assess uterine
tenderness
• Perform CTG if gestation 24 weeks or greater
• Perform sterile speculum examination, take swabs for liquor detection test and high and low
vaginal swabs for microscopy and culture
• Perform digital vaginal examination only if no contraindications exist and either:
o premature labour is suspected on clinical history or examination or
o cervix appears effaced or dilated on speculum
• Discuss findings with woman and document
cont’d ..../2
2. Obstetric Clinical Guidelines Group October 2009
ROYAL HOSPITAL FOR WOMEN
2.
Approved by
Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES
18/2/10
PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) – ASSESSMENT AND
MANAGEMENT GUIDELINE cont’d
Once PPROM is confirmed:
• Perform ultrasound
• Perform baseline full blood count (FBC) and mid-stream urine (MSU)
• Assess likelihood of pre-existing chorioamnionitis:
o maternal signs: temperature >37.8, tachycardia, offensive vaginal discharge,
leucocytosis (taking into account normal range for pregnancy and whether
steroids have been given) and uterine tenderness
o Fetal signs: fetal tachycardia
• Discuss with obstetric consultant:
o regarding immediate induction of labour (IOL) if high likelihood of pre-existing
chorioamnionitis
o ongoing management according to gestational age if low likelihood of
chorioamnionitis
Gestational age <20 weeks
• Counsel woman with spontaneous PPROM and severe oligohydramnios (amniotic fluid index
<2) regarding poor pregnancy prognosis and maternal risks of conservative management
• Offer and advise induction of labour
• Give antibiotic cover during induction or conservative management
• Offer second opinion from maternal fetal medicine (MFM) specialist if woman requesting
conservative management
• Offer social work support
Gestational age 20-24 weeks
• Counsel woman with spontaneous PPROM and severe oligohydramnios (amniotic fluid index
<2) regarding poor pregnancy prognosis and maternal risks of conservative management
• Offer second opinion from MFM specialist
• Offer induction of labour and give antibiotic cover during induction
• Offer social work support
• Advise the following if conservative management is chosen:
o admit woman for monitoring including temperature, maternal pulse and pad
checks at least three times a day
o give oral erythromycin 400mg qid for 10 days unless contraindications exist
o check fetal heart rate daily
o avoid vaginal or speculum examination unless preterm labour is suspected or
induction of labour is planned
o advise induction of labour if clinical signs of chorioamnionitis
• Offer neonatal consultation at 23-24 weeks to discuss administration of antenatal
corticosteroids and plans regarding neonatal resuscitation
• Advise the woman to avoid tampons, sex and immersion in water
Gestational age 24-37 weeks
• Counsel woman regarding maternal and fetal risks of PPROM, expected latency period, and
management
• Administer antenatal maternal corticosteroids if between 24 and 34 weeks gestation at
presentation
• Commence oral antibiotics (erythromycin 400mg qid for 10 days unless contraindications
exist)
• Consider tocolysis if indicated to achieve steroid cover
• Inform Newborn Care Centre and request neonatal consultation
• Offer social work support
cont’d ..../3
3. Obstetric Clinical Guidelines Group October 2009
ROYAL HOSPITAL FOR WOMEN
3.
Approved by
Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES
18/2/10
PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) – ASSESSMENT AND
MANAGEMENT GUIDELINE cont’d
•
•
•
•
•
•
Admit woman for monitoring, including:
o temperature, maternal pulse and pad checks at least three times a day
o fetal heart rate monitoring at least once per day
o repeat ultrasound in one week for measurement of amniotic fluid volume, then
fortnightly for growth
o weekly low vaginal swab and FBC or more frequently if clinically indicated
Avoid vaginal or speculum examination unless preterm labour or cord complications
suspected, or induction of labour planned
Advise delivery if clinical signs of chorioamnionitis
Consider possibility of abruption if new-onset vaginal bleeding: review maternal and fetal
status promptly
Consider alternative management options between 32 and 37 weeks’ gestation including:
o expectant management vs induction of labour
o outpatient management
Advise the woman to avoid tampons, sex and immersion in water
6. HAZARDS/SUB-OPTIMAL OUTCOMES
• Diagnosis of PPROM delayed or not made
• Antenatal corticosteroids not administered to woman with PPROM occurring between 24 and
34 weeks gestation
• Maternal and fetal morbidity/mortality secondary to chorioamnionitis
• Woman does not receive individualised counselling regarding management options for
PPROM and expected neonatal outcomes
7. DOCUMENTATION
• Integrated clinical notes
8. EDUCATIONAL NOTES
• Preterm premature rupture of membranes (<37 weeks gestation) occurs in 2 percent of
pregnancies and is responsible for approximately 40% of preterm births.5
• Maternal morbidity
o chorioamnionitis in 37%, postpartum endometritis in 11%, and sepsis in 1%3.
o placental abruption in at least 2%, with substantially higher risk if chorioamnionitis
is present.2
o caesarean delivery, including classical Caesarean for the very preterm infant or a
malpresentation
o Retained placenta
• Fetal/neonatal morbidity and mortality
o cord prolapse, risk of cord prolapse is 1-2% in PPROM with cephalic presentation
and up to 11% in PPROM with non-cephalic presentation.9
o pulmonary hypoplasia, is associated with gestational age <26 weeks at time of
PPROM, but is not universal even where PPROM occurs at <20 weeks
gestation12. There is no absolute antenatal predictor of the presence or absence
of pulmonary hypoplasia.
o neonatal mortality is strongly associated with lesser gestational age at PPROM,
presence of pulmonary hypoplasia at birth, and shorter latency period from
PPROM to delivery. Quoted mortality rates vary widely: for infants with
pulmonary hypoplasia mortality rates of 70-95% have been reported, and as
regards antenatal prediction, the combination of PPROM at <25 weeks and
severe oligohydramnios for >14 days carries a mortality rate of approximately
90%.12
o prognosis is improved in:
pregnancies with PPROM after amniocentesis, which have higher
likelihood of membrane resealing and fluid re-accumulation3
pregnancies where amniotic fluid index remains ≥2 after PPROM:
survival rates of up to 85% if the pregnancy continues to a viable
gestation are reported3.
5. Obstetric Clinical Guidelines Group October 2009
ROYAL HOSPITAL FOR WOMEN
4.
Approved by
Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES
18/2/10
PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) – ASSESSMENT AND
MANAGEMENT GUIDELINE cont’d
•
•
•
•
•
•
•
•
•
•
There are no universal diagnostic criteria for chorioamnionitis and no one sign or investigation
has adequate sensitivity or specificity for diagnosis. The criteria for the diagnosis of clinical
chorioamnionitis include: maternal pyrexia, tachycardia, leucocytosis, uterine tenderness,
offensive vaginal discharge and fetal tachycardia. 5 The sensitivity of leucocytosis ranges from
29-47% (a mildly elevated white cell count is normal in pregnancy), the sensitivity of vaginal
swabs is 53% with a false positive rate of 25%13. In a systematic review of 8 studies on the
use of CRP as a predictor of chorioamnionitis in PPROM (with CRP cut-off values ranging
between 5 and 40), only 3 of the 8 studies found that CRP had clinically useful predictive
value.11
Following corticosteroids administration there will usually be a transient rise in white cell
count for 48 hours.
Some clinicians would recommend the use of regular CRP as part of the evaluation of
chorioamnionitis
The use of antibiotics following PPROM is associated with an approximate 40% reduction in
chorioamnionitis (relative risk 0.57, 95% confidence interval 0.37-0.86), a 30% reduction in
neonatal infection, and a 20% reduction in abnormal neonatal head ultrasound scan prior to
discharge from hospital.8 There is also a 30% reduction in number of babies born within 48
hours and 20% reduction in number of babies born within 7 days.
Erythromycin is recommended as the first choice antibiotic as it was used in the single largest
randomised controlled trial on antibiotics for PRROM6, and does not appear to increase
neonatal morbidity or childhood disability at 7 year follow-up.7 Amoxycillin-clavulanate is not
recommended as it has been found to increase the rate of neonatal necrotising enterocolitis.6
Antibiotic administration following PPROM has not been shown to eradicate intrauterine
infection and does not prevent intrauterine infection from establishing.4
Neonatal mortality is reduced by approximately 40%, respiratory distress syndrome by 30%,
and cerebroventricular haemorrhage by 50% in infants of women who are given antenatal
corticosteroids within 24 hours of PPROM. Administration of antenatal steroids in the setting
of PPROM does not increase the likelihood of fetal death, maternal death, maternal fever,
chorioamnionitis or puerperal sepsis.10
The proportion of women remaining undelivered 10 days after PPROM is not higher in those
given tocolysis than in those receiving none. 5 As uterine contractions may be an indicator of
chorioamnionitis in PPROM, tocolysis should only be considered for the purposes of transfer
to a tertiary centre or to allow a course of antenatal corticosteroids to be completed.
One or two digital internal examinations versus no digital examinations has not been found to
worsen maternal or fetal outcome1, however it is associated with a shorter time from PPROM
to delivery (3 vs 5 days).
For viable fetuses it is currently unclear at what gestational age immediate induction (rather
than expectant management) should be offered. The incidence of neonatal respiratory
distress syndrome is lower following PPROM beyond 34 weeks gestation (but still up to 10%),
while maternal chorioamnionitis is approximately 2-3 times more common in expectantly
managed versus induced women at 34-37 weeks gestation. 5 There are currently randomised
controlled trials examining this issue.
9. RELATED POLICIES/ PROCEDURES/CLINICAL PRACTICE GUIDELINES
• Admission: midwifery
• ACTIM PROM: qualitative diagnosis of preterm premature rupture of membranes
• CTG policy – antenatal
• Estimation of Due Date
• Fetal heart rate monitoring
• Preterm labour suppression
• Vaginal swab – high
• Syntocinon induction or augmentation of labour
• Vaginal examinations in labour
cont’d ..../5
6. Obstetric Clinical Guidelines Group October 2009
ROYAL HOSPITAL FOR WOMEN
5.
Approved by
Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES
18/2/10
PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM) – ASSESSMENT AND
MANAGEMENT GUIDELINE cont’d
10. REFERENCES
1. Alexander JM, Mercer BM, Miodovnik M, et al. The impact of digital cervical examination on
expectantly managed preterm rupture of membranes. American Journal of Obstetrics and
Gynaecology 2000; 183: 1003-7.
2. Ananth CV, Oyelese Y, Srinivas N, et al. Preterm premature rupture of membranes,
intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstetrics
and Gynecology 2004 July; 104(1): 71-77.
3. Waters TP, Mercer BM. The management of preterm premature rupture of membranes near
the limit of fetal viability. American Journal of Obstetrics and Gynaecology 2009 Sep; 201:
230-240.
4. Gomez R, Romero R, Nien JK, et al. Antibiotic administration to patients with preterm
premature rupture of membranes does not eradicate intra-amniotic infection. Journal of
Maternal-Fetal and Neonatal Medicine 2007 Feb; 20(2): 167-73.
5. RCOG Guideline No. 44. Preterm prelabour rupture of membranes. Royal College of
Obstetricians and gynaecologists, Nov 2006.
6. Kenyon S, Taylor DJ, Tarnow-Mordi W, for the ORACLE Collaborative Group. Broadspectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE 1
randomised trial. Lancet 2001; 357:979-88.
7. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane
Database of Systematic Reviews 2003, Issue 2. Art. No.: CD001058. DOI:
10.1002/14651858.CD001058.
8. Kenyon S, Pike K, Jones DR, et al. Childhood outcomes after prescription of antibiotics to
pregnant women with preterm rupture of the membranes: 7 year follow-up of the ORACLE 1
trial.
9. Lewis D, Robichaux AG, Jaekle RK, et al. Expectant management of preterm premature
rupture of membranes and non-vertex presentation: what are the risks? American Journal of
Obstetrics and Gynecology 2007 June; 196: 556e1-566e6.
10.Roberts D, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation
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