This document discusses preterm labor and preterm rupture of membranes. It defines these conditions, explains their importance as major causes of perinatal death, and discusses the role of infection as a common cause. Risk factors for these conditions include a previous history of preterm delivery, smoking, uterine abnormalities, cervical incompetence, and infection. Proper management and preventive measures can help decrease incidence.
Prelabor rupture of membranes (PROM) occurs when the amniotic sac ruptures before the onset of labor. It can happen preterm (before 37 weeks) or at term (after 37 weeks). Risks of PROM include preterm birth, infection, and complications in the newborn like respiratory distress syndrome. Management depends on gestational age and risk of infection. Expectant management may be used if no infection and fetus is older than 34 weeks. Antibiotics are given to prevent infection and corticosteroids may be used to aid lung development if preterm.
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
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
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
Any bleeding during pregnancy should be considered abnormal. The etiology of bleeding varies depending on gestational age and can range from implantation bleeding to life-threatening hemorrhage. It is important to remember to administer Rho(D) immune globulin for Rh-negative women. Heavy bleeding with hemodynamic compromise requires immediate hospitalization.
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
Abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Pathologic conditions of the placenta include
Placental causes of hemorrhage,
Gestational trophoblastic disease,
Retained products of conception,
Nontrophoblastic placental tumors, metastases, and
Cystic lesions..
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
Prelabor rupture of membranes (PROM) occurs when the amniotic sac ruptures before the onset of labor. It can happen preterm (before 37 weeks) or at term (after 37 weeks). Risks of PROM include preterm birth, infection, and complications in the newborn like respiratory distress syndrome. Management depends on gestational age and risk of infection. Expectant management may be used if no infection and fetus is older than 34 weeks. Antibiotics are given to prevent infection and corticosteroids may be used to aid lung development if preterm.
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
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
1) Prolapsed umbilical cord occurs when the umbilical cord is displaced into or through the cervix during labor, putting pressure on the cord and restricting blood flow to the fetus.
2) Risk factors include non-cephalic fetal position, prematurity, polyhydramnios, multiple gestation, and disproportion between the fetus and pelvis.
3) Signs include variable fetal heart decelerations, palpation of the cord in the vagina or cervix, and fetal distress. Immediate management involves positioning the mother to relieve pressure on the cord and expedited delivery by cesarean section if the cervix is not fully dilated.
Any bleeding during pregnancy should be considered abnormal. The etiology of bleeding varies depending on gestational age and can range from implantation bleeding to life-threatening hemorrhage. It is important to remember to administer Rho(D) immune globulin for Rh-negative women. Heavy bleeding with hemodynamic compromise requires immediate hospitalization.
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
Abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Pathologic conditions of the placenta include
Placental causes of hemorrhage,
Gestational trophoblastic disease,
Retained products of conception,
Nontrophoblastic placental tumors, metastases, and
Cystic lesions..
This topic contains detail information about all abnormalities during puerperium like puerperial pyrexia, sepsis, subinvolution, breast complications, urinary complications, puerperal venous thrombosis, pulmonary embolism, obstetric palsies, puerperal emergencies, psychiatric disroders, perinatal management
This document discusses postpartum hemorrhage, which is defined as blood loss of 1000 mL or more within 24 hours of delivery. It is a leading cause of maternal mortality globally and in the US. Risk factors include previous hemorrhage, uterine issues, and medical/surgical history. Causes ("4 Ts") include tone (uterine atony), trauma, tissue (retained placenta), and thrombin (coagulopathy). Diagnosis involves assessment of vital signs and blood loss. Treatment involves oxytocin, uterine massage, fluids and identifying the cause. Early diagnosis and a coordinated response are important to reduce mortality from postpartum hemorrhage.
Labour is considered prolonged if it lasts more than 12 hours. It can be caused by issues with the passageway (pelvis), passenger (baby), powers (contractions), or psyche (mental state). Prolonged labour risks maternal and fetal complications if neglected. Close monitoring is needed to detect obstruction early. Treatment depends on fetal viability but may include resuscitating the mother, controlling infection, relieving obstruction via c-section, and post-delivery care like antibiotics and bladder drainage. Abnormal uterine contractions can also prolong labour and are treated with oxytocin.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
This document provides information on various methods of family planning and contraception, sexually transmitted diseases, and HIV/AIDS. It discusses natural family planning methods like calendar/rhythm and coitus interruptus methods, as well as chemical methods using oral contraceptives, injections, implants and spermicides. Barrier methods like condoms, diaphragms and intrauterine devices are also outlined. Other topics covered include male and female sterilization, advantages of breastfeeding, reasons for birth control and child spacing, common sexually transmitted diseases like gonorrhea and syphilis, and transmission/treatment of HIV/AIDS.
This document summarizes information about spontaneous abortion (miscarriage). It defines spontaneous abortion as the unintentional termination of a pregnancy before viability. The most common causes are identified as fetal chromosomal abnormalities in over 50% of early spontaneous abortions, with aneuploidy being the leading cause. Maternal factors like infections, endocrine abnormalities, nutrition deficiencies, drug/environmental exposures like smoking and alcohol are also discussed as potential contributing causes. The document provides detailed descriptions of the etiology, pathogenesis, clinical presentations and classifications of spontaneous abortion.
1. The document discusses various types of abortion including spontaneous, threatened, inevitable, incomplete, missed, and induced abortions.
2. Spontaneous abortion refers to abortion occurring without medical intervention, while induced abortion is intentionally caused.
3. Causes of abortion include fetal/ovum factors, maternal health issues, trauma, toxic agents, cervical/uterine abnormalities, and unknown causes.
4. Management depends on type and gestational age but may include bed rest, dilation and curettage, medications to expel products of conception, or hysterectomy in some cases.
Complications of the third stage of labourraj kumar
The document discusses complications of the third stage of labour, including postpartum haemorrhage, retained placenta, inversion of the uterus, and obstetric shock. It provides details on the definition, types, causes, diagnosis, and management of primary and secondary postpartum haemorrhage. Prevention focuses on correcting anemia during pregnancy and proper management during labor and delivery. Treatment includes restoring blood volume, arresting bleeding through massage, medications, compression, and ligation, and hysterectomy if needed.
The document discusses several changes that can occur to a woman's skin and underlying tissues during pregnancy. These include hyperpigmentation, melasma, hair and nail changes, vascular changes like spider telangiectases, glandular changes influencing sweating and acne, and connective tissue changes resulting in striae distensae. Several skin conditions like psoriasis and autoimmune disorders may also be influenced by pregnancy. Specific conditions that can occur include herpes gestationis, PUPPP, intrahepatic cholestasis of pregnancy, and pruritic folliculitis. The use of various drugs during pregnancy is also addressed, with categories assigned based on potential fetal risk.
Uterine malformation Define, Types,Diagnosis Test,Treatment in word File Use ...sonal patel
This document discusses uterine malformations, which result from abnormal development of the Müllerian duct during embryogenesis. It describes the different classifications of uterine malformations according to the American Fertility Society. The most common type is a septate uterus, which occurs when the intervening uterovaginal septum fails to completely resorb after the Müllerian ducts fuse. Surgical resection of a uterine septum can help decrease miscarriage rates for women with this anomaly. The document also discusses the normal development of the female reproductive system from the Müllerian ducts and how failures during this process can lead to various uterine malformations.
Antepartum hemorrhage (APH) refers to bleeding from or into the genital tract occurring between 24 weeks of pregnancy until birth. It can be caused by placenta previa, where the placenta covers part or all of the cervix, or placental abruption, where the placenta prematurely separates from the uterine wall. Women experiencing APH should be admitted to the hospital for monitoring and treatment, which may include expectant care with bed rest or emergency delivery by cesarean section depending on gestational age and severity of bleeding. APH can threaten the lives of both mother and baby if not properly managed.
Late pregnancy bleeding can be caused by several conditions including abruption placenta, placenta previa, vasa previa, and uterine rupture. Abruption placenta involves the separation of the placenta from the uterus before delivery and can range from mild to severe. Placenta previa occurs when the placenta implants in the lower uterine segment which can cause painless bleeding. Vasa previa involves blood vessels crossing over the cervical opening which can lead to exsanguination of the fetus if ruptured. Uterine rupture is a complete tear of the uterus wall which endangers the mother and fetus. Immediate delivery is usually required for management of these conditions.
The document discusses several placental anomalies including bilobed, multilobed, succenturiate, circumvallate, battledore, velamentous cord insertion, vasa previa, placenta accreta, increta, and percreta. It defines each anomaly, describes their clinical significance and risks, and provides images. It also discusses causes, symptoms, risk factors, and therapeutic management for some anomalies. The document is presented as part of a lecture on placental anomalies for maternal and child nursing students.
This document discusses antepartum hemorrhage, specifically placenta previa and abruption placentae. It defines each condition, describes their causes, clinical features, complications, types or degrees in the case of placenta previa, management, and prevention. Placenta previa is defined as a low implantation of the placenta in the uterus causing it to lie alongside or in front of the presenting part, often causing painless bleeding in the third trimester. Abruptio placentae is the premature separation of a normally situated placenta, which can result in both revealed and concealed bleeding. Management of both aims to prevent bleeding through antenatal care, diagnosis and hospitalization for
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Symptoms can include abdominal pain and bleeding. Diagnosis is made through ultrasound and beta-hCG blood tests. Treatment depends on the location and stability of the patient, and may include surgery, medication with methotrexate, or expectant management. Complications can include tubal rupture in 20-30% of cases.
This document discusses hydatidiform mole, a rare abnormal pregnancy where the placenta develops abnormally. There are two types - complete and partial mole. Complete mole occurs when the placenta grows abnormally but there is no fetus. Partial mole occurs when both normal and abnormal placental tissue develops along with a non-viable fetus. Symptoms include vaginal bleeding, nausea, vomiting and rapid uterine growth. Diagnosis involves ultrasound, blood tests and tissue examination. Treatment is usually surgical evacuation of the uterus. Follow up is needed to monitor for complications like hemorrhage and ensure no remaining molar tissue.
This document provides information on antepartum hemorrhage (APH) including definitions, causes, risk factors, clinical presentations, diagnoses, and management strategies. It covers two main causes of APH - placental abruption and placenta previa. Placental abruption is defined as premature separation of the placenta and can cause both concealed and revealed bleeding. It accounts for 40% of APH cases. Placenta previa refers to placenta implanted over the cervical os and is a risk factor for painless third trimester bleeding. Sonography and history are used to diagnose the cause of bleeding and determine management, whether expectant, medical, or termination of pregnancy.
1) Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can lead to maternal death if left untreated.
2) Risk factors for ectopic pregnancy include previous pelvic infections, IUD use, infertility treatments, and previous ectopic pregnancies or pelvic surgeries.
3) Clinical presentation varies from acute abdominal pain and shock due to tubal rupture to more subtle symptoms like abdominal pain and vaginal bleeding. Diagnosis is confirmed through transvaginal ultrasound and tests of beta-hCG levels and progesterone.
4) Treatment depends on severity but may include medication with methotrexate
Labor: Childbirth, the process of delivering a baby and the placenta, membranes, and umbilical cord from the uterus to the vagina to the outside world. During the first stage of labor (which is called dilation), the cervix dilates fully to a diameter of about 10 cm (2 inches).
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
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#Health #Medical #News #Physiotherapy
This document discusses the relationship between preterm birth, antibiotics, and cerebral palsy. It summarizes several studies and reviews on this topic. The main points are:
1) Prescribing antibiotics to women in preterm labor has unclear effects, with some evidence it may increase the risk of cerebral palsy and functional impairment in children.
2) For women with preterm premature rupture of membranes (PPROM), antibiotics reduce some short-term risks but do not improve long-term outcomes or reduce cerebral palsy rates.
3) More research is still needed to fully understand the impacts of antibiotic use in preterm labor and how it relates to cerebral palsy and child development.
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.
This document discusses postpartum hemorrhage, which is defined as blood loss of 1000 mL or more within 24 hours of delivery. It is a leading cause of maternal mortality globally and in the US. Risk factors include previous hemorrhage, uterine issues, and medical/surgical history. Causes ("4 Ts") include tone (uterine atony), trauma, tissue (retained placenta), and thrombin (coagulopathy). Diagnosis involves assessment of vital signs and blood loss. Treatment involves oxytocin, uterine massage, fluids and identifying the cause. Early diagnosis and a coordinated response are important to reduce mortality from postpartum hemorrhage.
Labour is considered prolonged if it lasts more than 12 hours. It can be caused by issues with the passageway (pelvis), passenger (baby), powers (contractions), or psyche (mental state). Prolonged labour risks maternal and fetal complications if neglected. Close monitoring is needed to detect obstruction early. Treatment depends on fetal viability but may include resuscitating the mother, controlling infection, relieving obstruction via c-section, and post-delivery care like antibiotics and bladder drainage. Abnormal uterine contractions can also prolong labour and are treated with oxytocin.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
This document provides information on various methods of family planning and contraception, sexually transmitted diseases, and HIV/AIDS. It discusses natural family planning methods like calendar/rhythm and coitus interruptus methods, as well as chemical methods using oral contraceptives, injections, implants and spermicides. Barrier methods like condoms, diaphragms and intrauterine devices are also outlined. Other topics covered include male and female sterilization, advantages of breastfeeding, reasons for birth control and child spacing, common sexually transmitted diseases like gonorrhea and syphilis, and transmission/treatment of HIV/AIDS.
This document summarizes information about spontaneous abortion (miscarriage). It defines spontaneous abortion as the unintentional termination of a pregnancy before viability. The most common causes are identified as fetal chromosomal abnormalities in over 50% of early spontaneous abortions, with aneuploidy being the leading cause. Maternal factors like infections, endocrine abnormalities, nutrition deficiencies, drug/environmental exposures like smoking and alcohol are also discussed as potential contributing causes. The document provides detailed descriptions of the etiology, pathogenesis, clinical presentations and classifications of spontaneous abortion.
1. The document discusses various types of abortion including spontaneous, threatened, inevitable, incomplete, missed, and induced abortions.
2. Spontaneous abortion refers to abortion occurring without medical intervention, while induced abortion is intentionally caused.
3. Causes of abortion include fetal/ovum factors, maternal health issues, trauma, toxic agents, cervical/uterine abnormalities, and unknown causes.
4. Management depends on type and gestational age but may include bed rest, dilation and curettage, medications to expel products of conception, or hysterectomy in some cases.
Complications of the third stage of labourraj kumar
The document discusses complications of the third stage of labour, including postpartum haemorrhage, retained placenta, inversion of the uterus, and obstetric shock. It provides details on the definition, types, causes, diagnosis, and management of primary and secondary postpartum haemorrhage. Prevention focuses on correcting anemia during pregnancy and proper management during labor and delivery. Treatment includes restoring blood volume, arresting bleeding through massage, medications, compression, and ligation, and hysterectomy if needed.
The document discusses several changes that can occur to a woman's skin and underlying tissues during pregnancy. These include hyperpigmentation, melasma, hair and nail changes, vascular changes like spider telangiectases, glandular changes influencing sweating and acne, and connective tissue changes resulting in striae distensae. Several skin conditions like psoriasis and autoimmune disorders may also be influenced by pregnancy. Specific conditions that can occur include herpes gestationis, PUPPP, intrahepatic cholestasis of pregnancy, and pruritic folliculitis. The use of various drugs during pregnancy is also addressed, with categories assigned based on potential fetal risk.
Uterine malformation Define, Types,Diagnosis Test,Treatment in word File Use ...sonal patel
This document discusses uterine malformations, which result from abnormal development of the Müllerian duct during embryogenesis. It describes the different classifications of uterine malformations according to the American Fertility Society. The most common type is a septate uterus, which occurs when the intervening uterovaginal septum fails to completely resorb after the Müllerian ducts fuse. Surgical resection of a uterine septum can help decrease miscarriage rates for women with this anomaly. The document also discusses the normal development of the female reproductive system from the Müllerian ducts and how failures during this process can lead to various uterine malformations.
Antepartum hemorrhage (APH) refers to bleeding from or into the genital tract occurring between 24 weeks of pregnancy until birth. It can be caused by placenta previa, where the placenta covers part or all of the cervix, or placental abruption, where the placenta prematurely separates from the uterine wall. Women experiencing APH should be admitted to the hospital for monitoring and treatment, which may include expectant care with bed rest or emergency delivery by cesarean section depending on gestational age and severity of bleeding. APH can threaten the lives of both mother and baby if not properly managed.
Late pregnancy bleeding can be caused by several conditions including abruption placenta, placenta previa, vasa previa, and uterine rupture. Abruption placenta involves the separation of the placenta from the uterus before delivery and can range from mild to severe. Placenta previa occurs when the placenta implants in the lower uterine segment which can cause painless bleeding. Vasa previa involves blood vessels crossing over the cervical opening which can lead to exsanguination of the fetus if ruptured. Uterine rupture is a complete tear of the uterus wall which endangers the mother and fetus. Immediate delivery is usually required for management of these conditions.
The document discusses several placental anomalies including bilobed, multilobed, succenturiate, circumvallate, battledore, velamentous cord insertion, vasa previa, placenta accreta, increta, and percreta. It defines each anomaly, describes their clinical significance and risks, and provides images. It also discusses causes, symptoms, risk factors, and therapeutic management for some anomalies. The document is presented as part of a lecture on placental anomalies for maternal and child nursing students.
This document discusses antepartum hemorrhage, specifically placenta previa and abruption placentae. It defines each condition, describes their causes, clinical features, complications, types or degrees in the case of placenta previa, management, and prevention. Placenta previa is defined as a low implantation of the placenta in the uterus causing it to lie alongside or in front of the presenting part, often causing painless bleeding in the third trimester. Abruptio placentae is the premature separation of a normally situated placenta, which can result in both revealed and concealed bleeding. Management of both aims to prevent bleeding through antenatal care, diagnosis and hospitalization for
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Symptoms can include abdominal pain and bleeding. Diagnosis is made through ultrasound and beta-hCG blood tests. Treatment depends on the location and stability of the patient, and may include surgery, medication with methotrexate, or expectant management. Complications can include tubal rupture in 20-30% of cases.
This document discusses hydatidiform mole, a rare abnormal pregnancy where the placenta develops abnormally. There are two types - complete and partial mole. Complete mole occurs when the placenta grows abnormally but there is no fetus. Partial mole occurs when both normal and abnormal placental tissue develops along with a non-viable fetus. Symptoms include vaginal bleeding, nausea, vomiting and rapid uterine growth. Diagnosis involves ultrasound, blood tests and tissue examination. Treatment is usually surgical evacuation of the uterus. Follow up is needed to monitor for complications like hemorrhage and ensure no remaining molar tissue.
This document provides information on antepartum hemorrhage (APH) including definitions, causes, risk factors, clinical presentations, diagnoses, and management strategies. It covers two main causes of APH - placental abruption and placenta previa. Placental abruption is defined as premature separation of the placenta and can cause both concealed and revealed bleeding. It accounts for 40% of APH cases. Placenta previa refers to placenta implanted over the cervical os and is a risk factor for painless third trimester bleeding. Sonography and history are used to diagnose the cause of bleeding and determine management, whether expectant, medical, or termination of pregnancy.
1) Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can lead to maternal death if left untreated.
2) Risk factors for ectopic pregnancy include previous pelvic infections, IUD use, infertility treatments, and previous ectopic pregnancies or pelvic surgeries.
3) Clinical presentation varies from acute abdominal pain and shock due to tubal rupture to more subtle symptoms like abdominal pain and vaginal bleeding. Diagnosis is confirmed through transvaginal ultrasound and tests of beta-hCG levels and progesterone.
4) Treatment depends on severity but may include medication with methotrexate
Labor: Childbirth, the process of delivering a baby and the placenta, membranes, and umbilical cord from the uterus to the vagina to the outside world. During the first stage of labor (which is called dilation), the cervix dilates fully to a diameter of about 10 cm (2 inches).
Bhaskar Health News and Medical Education is leading source for trustworthy health, medical, science and technology news and information. Providing world health information Medical Education.
Bhaskar Health News and Medical Education is dedicated to medical students, physiotherapists, doctors, nurses, paramedics, physician associates, dentists, pharmacists, midwives and other healthcare professionals.
We're committed to being your source for expert health guidance. Bhaskar Health and Medical Education.
Source : https://www.bhaskarhealth.com
Health Shop: https://www.bhaskarhealth.org
@drrohitbhaskar @bhaskarhealth
#DrRohitBhaskar #BhaskarHealth
#Health #Medical #News #Physiotherapy
This document discusses the relationship between preterm birth, antibiotics, and cerebral palsy. It summarizes several studies and reviews on this topic. The main points are:
1) Prescribing antibiotics to women in preterm labor has unclear effects, with some evidence it may increase the risk of cerebral palsy and functional impairment in children.
2) For women with preterm premature rupture of membranes (PPROM), antibiotics reduce some short-term risks but do not improve long-term outcomes or reduce cerebral palsy rates.
3) More research is still needed to fully understand the impacts of antibiotic use in preterm labor and how it relates to cerebral palsy and child development.
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.
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
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.
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.
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.
This document provides guidelines for managing pregnancies of unknown location (PUL). It states that women with a PUL could have an ectopic pregnancy until the location is determined. Serum hCG measurements should only be used to assess trophoblastic proliferation and help determine management, not to determine pregnancy location. Clinical symptoms are more important than hCG levels, and women should be monitored if symptoms change. The guidelines provide recommendations for next steps based on whether hCG levels increase or decrease more than 63% or 50% over 48 hours. Ultrasound or clinical review is recommended in certain scenarios to identify pregnancy location. Progesterone measurements should not be used to diagnose pregnancy type when using serial hCG tests to manage a PUL.
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 provides guidelines for the prevention and management of preterm labour. It includes:
1. Definitions of key terms like suspected preterm labour, diagnosed preterm labour, and rescue cervical cerclage.
2. Recommendations for prevention of preterm labour, including prophylactic progesterone, cervical cerclage, and indications for rescue cerclage.
3. Guidance on diagnosis of preterm labour through clinical assessment, transvaginal ultrasound to measure cervical length, and fetal fibronectin testing.
4. Treatment options including tocolysis with calcium blockers, corticosteroids, magnesium sulfate, fetal monitoring, and discussions on mode of birth. The guidelines provide
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.
1) Recent research has found that fetal fibronectin testing and ultrasound assessment of cervical length can help predict preterm birth in symptomatic women, though fetal fibronectin may have limited accuracy within 7 days.
2) Nifedipine and atosiban appear to be effective tocolytic options with fewer side effects than alternatives like ritodrine and indomethacin. Tocolysis is generally not continued past 48 hours except in special cases.
3) Antenatal corticosteroids between 24-34 weeks can help reduce fetal morbidity from preterm birth. Routine antibiotics without ruptured membranes do not prolong pregnancy or improve neonatal outcomes. Bed rest does not lower preterm
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Maternal Care: Preterm labour and preterm rupture of the membranesSaide OER Africa
Maternal Care addresses all the common and important problems that occur during pregnancy, labour, delivery and the puerperium. It covers: the antenatal and postnatal care of healthy women with normal pregnancies, monitoring and managing the progress of labour, specific medical problems during pregnancy, labour and the puerperium, family planning, regionalised perinatal care
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DISORDERS OF PREGNANCY AND PLACENTA.
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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.
Preterm delivery : Preterm labour and PPROM Jwan AlSofi
This document discusses preterm delivery and labor, including definitions, causes, risk factors, clinical features, investigations, and management. It begins with an overview of spontaneous preterm labor and preterm premature rupture of membranes. Key points include that infection is a major cause, cervical weakness can lead to ascending infection, and multiple pregnancies have an increased risk. Clinical assessment includes examination and testing fetal fibronectin and cervical length via ultrasound. Management aims to delay delivery and improve neonatal outcomes through treatments like corticosteroids and antibiotics.
This document discusses the pathophysiology of preterm birth, which accounts for 6-10% of births and is a major cause of neonatal death and impairment. Risk factors include race, age, socioeconomic status, BMI, smoking, and stress. Preterm birth is caused by inflammation/infection, hormonal changes, cervical insufficiency, and genetic factors. It can be predicted using tests for fetal fibronectin and cervical length. Prevention methods include cervical cerclage, progesterone supplementation, and antibiotics in some cases. The goal of treatment is to inhibit preterm labor when possible and ensure delivery occurs in a facility equipped for neonatal care.
1) Premature rupture of membranes (PROM) before 37 weeks can occur spontaneously or be caused by infection, physical factors like contractions, or connective tissue disorders. Infection is a major cause.
2) Risk factors for preterm PROM include prior preterm birth, short cervix, low socioeconomic status, smoking, bleeding, infections like bacterial vaginosis, and physical factors like polyhydramnios or cervical procedures.
3) While many risk factors are known, preterm PROM cannot be reliably predicted and usually the specific cause is not clear. Preventing infection and physical causes may help reduce preterm PROM risk.
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.
10.2 Preterm labour and preterm rupture of the membranes.pdfChantal Settley
This document discusses preterm labour and preterm rupture of membranes. It defines these conditions and notes that infection is a major cause. Patients at increased risk include those with a prior history. Diagnosis involves assessing contractions and cervical changes. Management includes identifying treatable causes, suppressing contractions with medications like nifedipine or salbutamol, and transferring high-risk mothers to facilities equipped for premature infants. The goal is prolonging the pregnancy whenever safely possible to improve neonatal outcomes.
Pre-labor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor.
Women usually experience a painless gush or a steady leakage of fluid from the vagina.
If it occurs before 37 weeks it is known as PPROM (‘preterm’ prelabour rupture of membranes) otherwise it is known as term PROM.
Premature labour, also known as preterm labour, occurs when a woman goes into labour before 37 weeks of gestation. It accounts for 5-10% of all deliveries and is a major cause of neonatal mortality and morbidity. The causes are often multifactorial and can include demographic factors, reproductive history, uterine factors, and infections. Management depends on factors such as gestational age, fetal well-being, and availability of neonatal intensive care and may involve tocolysis, corticosteroids, antibiotics, and monitoring for signs of infection.
Chorioamnionitis and PROM - Nahrain UniversityAli Al-Shimmary
Chorioamnionitis is an inflammation of the fetal membranes caused by bacterial infection, usually ascending from the vagina during prolonged labor. It complicates 1-4% of births in the US and 40-70% of preterm births following premature rupture of membranes or spontaneous labor. Risk factors include prolonged rupture of membranes, prolonged labor, nulliparity, smoking, and bacterial vaginosis. Diagnosis is based on maternal fever, uterine tenderness, and fetal tachycardia. Treatment involves intravenous antibiotics until delivery. Complications for both mother and fetus include sepsis, pneumonia, and cerebral palsy. Premature rupture of membranes can occur preterm or at term and increases risks of infection, cord prolapse
This document discusses obstetric emergencies, including prolapse of the umbilical cord, amniotic fluid embolism, and rupture of the uterus. It provides definitions, risk factors, signs and symptoms, and management steps for each emergency. The key points are rapid assessment and relief of pressure on the cord for prolapse, management of respiratory distress and cardiovascular collapse for amniotic embolism, and determining the type of rupture before performing hysterectomy or repair for a ruptured uterus. Prevention focuses on careful antenatal care, monitoring high-risk mothers, and avoiding unnecessary interventions.
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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.
Mercer Clin Perinatol 2004, Rpm Diagnosis And ManagementEliana Cordero
1) Preterm premature rupture of the membranes (PROM) complicates approximately 8% of pregnancies and is responsible for about one third of preterm births.
2) The diagnosis of PROM is usually made clinically based on history, physical exam, and adjunctive tests showing fluid leakage. Management depends on gestational age and factors necessitating delivery.
3) For previable PROM (before 23 weeks), expeditious delivery is usually recommended given the high risks of maternal complications and fetal/neonatal death. Conservative management may be considered with strict monitoring and bed rest.
1. Obstructed labour occurs when the baby is unable to descend through the birth canal due to issues like a small pelvis, large baby, or abnormal presentation. It can lead to prolonged labour, fetal distress, and rupture of the uterus or development of fistulas.
2. Umbilical cord prolapse is a medical emergency where the cord precedes the baby during delivery. It cuts off oxygen to the baby. Immediate delivery via c-section is usually needed to prevent brain damage or death.
3. Uterine rupture is a serious complication during labour where the uterine wall tears. It commonly occurs during labour in women with a prior c-section scar. Symptoms may include abdominal pain
ectopic pregnancy for medical students to studymelaniemathew1
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. This presents a risk of death 10 times greater than a vaginal delivery due to potential bleeding. Factors that can increase the risk of ectopic pregnancy include previous pelvic infections, endometriosis, tubal abnormalities, smoking, assisted reproduction procedures, and failed contraception. Without treatment, ectopic pregnancies often rupture the fallopian tube.
This document summarizes various sites of embryo implantation and placental abnormalities in pregnancy. It describes normal implantation in the uterus and discusses abnormal locations including placenta praevia where the placenta is close to or covers the cervix. Rare sites of ectopic pregnancy outside the uterus are also outlined. The document then examines placental abnormalities categorized by shape, implantation site and degenerative lesions. Specific conditions like placenta accreta where the placenta invades the uterus are defined. In summary, the key sites of abnormal embryo implantation and classifications of placental anomalies are concisely presented.
This document summarizes guidelines for the management of premature rupture of membranes (PROM). It defines PROM and discusses the risks and outcomes associated with term and preterm PROM. For term PROM at 37 weeks or later, the document recommends inducing labor over expectant management to reduce infection risks and speed delivery. For preterm PROM, it recommends considering delivery versus expectant management based on gestational age and fetal status. While the optimal timing remains unclear, data suggest delivery between 34-37 weeks may reduce infection risks without increasing neonatal risks.
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Primary maternal care preterm labour and preterm rupture of the membranes
1. 5
Preterm labour
and preterm
rupture of the
membranes
Before you begin this unit, please take the PRETERM LABOUR AND
corresponding test at the end of the book to
assess your knowledge of the subject matter. You PRETERM RUPTURE OF
should redo the test after you’ve worked through THE MEMBRANES
the unit, to evaluate what you have learned.
Objectives 5-1 What is preterm labour?
Preterm labour is diagnosed when there are
When you have completed this unit you regular uterine contractions before 37 weeks of
should be able to: pregnancy, together with either of the following:
• Define preterm labour and preterm 1. Cervical effacement and/or dilatation.
rupture of the membranes. 2. Rupture of the membranes.
• Understand why these conditions are
very important. 5-2 What is preterm rupture
• Understand the role of infection in of the membranes?
causing preterm labour and preterm Preterm rupture of the membranes is
rupture of the membranes. diagnosed when the membranes rupture before
• List which patients are at increased risk 37 weeks, in the absence of uterine contractions.
of these conditions and what preventive
measures should be taken. 5-3 What is prelabour rupture
of the membranes?
• Diagnose preterm labour and preterm
rupture of the membranes. Prelabour rupture of the membranes is defined
• Initiate the correct management and as rupture of the membranes for at least one hour
before the onset of labour in a term pregnancy.
appropriate referral of patients.
2. PRETERM LABOUR AND PRETERM RUPTURE OF THE MEMBRANES 97
5-4 How should you diagnose preterm membranes and placenta. Later these bacteria
labour if the gestational age is unknown? may colonise the liquor, from where they may
infect the fetus.
Preterm labour is diagnosed if the estimated
fetal weight is below 2500 g. The symphysis- Infection of the membranes and placenta
fundus height will be less than 35 cm.
(chorioamnionitis) may occur with either intact
or ruptured membranes.
5-5 Why are preterm labour and preterm
rupture of the membranes important?
5-8 What is the clinical presentation
Preterm labour and preterm rupture of the
of chorioamnionitis?
membranes are major causes of perinatal
death because: Usually chorioamnionitis is asymptomatic
(subclinical chorioamnionitis) and, therefore,
1. Preterm delivery, especially before 34 weeks,
the clinical diagnosis is often not made.
commonly results in the birth of an infant
However, the following signs may be present:
who develops hyaline membrane disease
and other complications of prematurity. 1. Fetal tachycardia.
2. Preterm labour and preterm rupture of 2. Maternal pyrexia and/or tachycardia.
the membranes are often accompanied by 3. Tenderness of the uterus.
bacterial infection of the membranes and 4. Drainage of offensive liquor, if the
placenta, that may cause complications for membranes have ruptured.
both the mother and the fetus. The mother
If any of the above signs are present, a diagnosis
and fetus may develop severe infection,
of clinical chorioamnionitis must be made.
which is life threatening.
5-9 What factors may predispose
5-6 What is the commonest known
to chorioamnionitis?
cause of preterm labour and preterm
rupture of the membranes? 1. Rupture of the membranes.
2. Exposure of the membranes due to
In many cases the cause is unknown, but
dilatation of the cervix.
increasing evidence points to infection of the
3. Coitus during the second half of
membranes and placenta as the commonest
pregnancy.
known cause of both preterm labour and
preterm rupture of the membranes. However, in many cases, the factors that result
in chorioamnionitis are not known.
Infection of the membranes and placenta is the
commonest recognised cause of preterm labour 5-10 Can chorioamnionitis cause
and preterm rupture of the membranes. complications during the puerperium?
Yes, it can cause serious problems.
5-7 What is infection of the 1. Bacteria that have colonised the amniotic
membranes and placenta? fluid, may infect the fetus and the infant
Infection of the membranes and placenta may present with signs of infection
causes an acute inflammation of the placenta, (congenital pneumonia or septicaemia) at
membranes and decidua. This condition is or soon after birth.
called chorioamnionitis. It may occur with 2. Chorioamnionitis may cause infection of
intact or ruptured membranes. the genital tract (puerperal sepsis) which,
if not treated correctly, may result in
Bacteria from the cervix and vagina spread
septicaemia, the need for hysterectomy,
through the endocervical canal to infect the
and possibly in maternal death. These
3. 98 PRIMAR Y MATERNAL CARE
complications can usually be prevented 7. Have any of the maternal, fetal or placental
by starting a course of broad-spectrum factors listed above.
antibiotics (e.g. intravenous ampicillin plus
metronidazole), as soon as the diagnosis of The most important risk factor for preterm
clinical chorioamnionitis is made. labour is a previous history of preterm delivery.
5-11 What factors other than
5-13 What can be done to decrease the
chorioamnionitis can lead to
incidence of these complications?
preterm labour and preterm
rupture of the membranes? 1. Take measures to ensure that all pregnant
women receive antenatal care.
The following maternal, fetal and placental
2. Identify patients with a past history of
factors may be associated with preterm labour
preterm labour.
and/or preterm rupture of the membranes:
3. Give advice about the dangers of smoking,
1. Maternal factors: alcohol and the use of habit-forming drugs.
• Pyrexia, as the result of an acute 4. Advise against coitus during the late 2nd
infection other than chorioamnionitis, and in the 3rd trimester in pregnancies at
e.g. acute pyelonephritis or malaria. high risk for preterm labour or preterm
• Uterine abnormalities, such as rupture of the membranes. If coitus occurs
congenital uterine malformations during pregnancy in these patients, the use
(e.g. septate or bicornuate uterus) and of condoms must be recommended as this
uterine myomas (fibroids). may reduce the risk of chorioamnionitis.
• Incompetence of the internal cervical 5. Insert a McDonald suture at 14–16 weeks,
os (‘cervical incompetence’). in patients with a proven incompetent
2. Fetal factors: internal cervical os.
• A multiple pregnancy. 6. Prevent teenage pregnancies.
• Polyhydramnios 7. Improve the socio-economic and
• Congenital malformations of the fetus. nutritional status of poor communities.
• Syphilis. 8. Arrange that the workload of women,
3. Placental factors: who have to do heavy manual labour, is
• Placenta praevia. decreased when they are pregnant and
• Abruptio placentae. that an opportunity to rest during working
hours is allowed.
5-12 Which patients are at an increased
risk of preterm labour or preterm 5-14 How should you manage a patient
rupture of the membranes? at increased risk of preterm labour or
preterm rupture of the membranes?
Both preterm labour and preterm rupture of
membranes are more common in patients who: 1. Patients at increased risk must have 2
weekly vaginal examinations from 24
1. Have a past history of preterm labour.
weeks, in order to make an early diagnosis
2. Have no antenatal care.
of preterm cervical effacement and/or
3. Live in poor socio-economic
dilatation.
circumstances.
2. In all women with cervical effacement or
4. Smoke, use alcohol or abuse habit-forming
dilatation before 34 weeks, the following
drugs.
preventive measures can then be taken:
5. Are underweight due to undernutrition.
• Bed rest. This can be at home, except
6. Have coitus in the 2nd half of pregnancy,
when the home circumstances are poor,
when they are at an increased risk of
preterm labour or infections.
4. PRETERM LABOUR AND PRETERM RUPTURE OF THE MEMBRANES 99
in which case the patient should be DIAGNOSIS OF
referred to the hospital for admission.
• Sick leave must be arranged for PRETERM LABOUR AND
working patients. PRETERM RUPTURE OF
• Coitus must be forbidden.
• Advice must be given to report THE MEMBRANES
immediately, if contractions or rupture
of the membranes occur.
• Women with preterm labour or preterm 5-16 How should you distinguish
rupture of the membranes must be seen between Braxton Hicks contractions and
as soon as possible, and the correct the contractions of preterm labour?
measures taken to prevent the delivery Braxton Hicks contractions:
of a severely preterm infant.
1. Are irregular.
All patients should be told to immediately 2. May cause discomfort but are not painful.
report preterm labour or preterm rupture of the 3. Do not increase in duration or frequency.
4. Do not cause cervical effacement or
membranes.
dilatation.
The duration of contractions cannot be used
5-15 What should you do if a patient as Braxton Hicks contractions may last up to
threatens to deliver a preterm infant? 60 seconds.
1. Infants born between 34 and 36 weeks can In contrast, the contractions of preterm or
usually be cared for in a level 1 hospital. early labour:
2. However, women who threaten to deliver
between 28 and 33 weeks, should be 1. Are regular, at least one per 10 minutes.
referred to a level 2 or 3 hospital with a 2. Are painful.
neonatal intensive care unit. 3. Increase in frequency and duration.
3. If the birth of a preterm baby cannot be 4. Cause effacement and dilatation of the
prevented, it must be remembered that the cervix.
best incubator for transporting an infant
is the mother’s uterus. Even if the delivery 5-17 How should you confirm the
is inevitable, an attempt to suppress labour diagnosis of preterm labour?
should be made, so that the patient can be
Both of the following will be present in a
transferred before the infant is born.
patient of less than 37 weeks gestation:
4. The better the condition of the infant on
arrival at the neonatal intensive care unit, 1. Regular uterine contractions, palpable on
the better is the prognosis. abdominal examination, of at least one
per 10 minutes.
2. A history of rupture of the membranes, or
cervical effacement and/or dilatation on
vaginal examination.
5-18 How can you diagnose preterm
rupture of the membranes?
1. A patient of less than 37 weeks gestation
will give a history of sudden drainage
of liquor followed by a continual leak
5. 100 PRIMAR Y MATERNAL CARE
of smaller amounts, without associated indicating that the membranes have
uterine contractions. ruptured. If blue litmus is used, it will
2. A sterile speculum examination will remain blue with rupture of membranes or
confirm the diagnosis of ruptured change to red if the membranes are intact.
membranes.
3. A digital vaginal examination must not be 5-21 How should you manage
done as it is of little value in diagnosing patients with preterm labour,
rupture of the membranes and may preterm rupture of membranes and
increase the risk of infection. prelabour rupture of membranes?
A digital vaginal examination must not be done 1. If the gestational age is less than 36 weeks,
in preterm rupture of the membranes. these patients should be referred to a level
I hospital for admission. If the gestational
age is less than 34 weeks, she must be
5-19 What is the value of a sterile referred to a level 2 hospital.
speculum examination when preterm 2. If the gestational age is 36 weeks of more,
rupture of the membranes is suspected? patients can safely be delivered in a midwife
obstetric unit (MOU) or district hospital.
1. The danger of ascending infection is not
At a gestational age of 36 weeks babies will
increased by this procedure.
not develop the complications of preterm
2. Observing drainage of liquor from the
infants and could be discharged 6 hours
cervical os confirms the diagnosis of
following delivery with their mothers.
ruptured membranes.
3. If no drainage of liquor is observed,
drainage can sometimes be seen if the 5-22 How will you decide that a patient
patient is asked to cough. is less than 36 weeks pregnant if the
4. If no drainage of liquor is seen, a smear duration of the pregnancy is unknown?
should be taken from the posterior This is done by measuring the symphysis-
vaginal fornix with a wooden spatula to fundus height and by doing a complete
determine the pH. abdominal examination. An estimated fetal
5. The possibility of cord prolapse can be weight of less than 2500 g, suggests a gestational
excluded or confirmed. age of less than 36 weeks. The symphysis-fundus
6. It is also important to see whether the height measurement will be less than 34 cm.
cervix is long and closed, or whether
there is already clear evidence of cervical 5-23 What should be done if preterm
effacement and/or dilatation. labour has been diagnosed and the
7. A patient with a profuse vaginal discharge patient is less than 34 weeks pregnant?
or stress incontinence (leaking urine
when coughing or laughing) may think Contractions should be suppressed with
that she is draining liquor. A speculum nifedipine (Adalat). The patient must then
examination will help to confirm or rule be transferred as an urgent transferal to a
out this possibility. level 2 hospital. If nifedipine is not available
salbutamol (Ventolin) can be used. This
5-20 How should you test the vaginal pH? measure will:
1. The pH of the vagina is acid but the pH of 1. Improve the chance of successful
liquor is alkaline. suppression of preterm labour at the
2. Red litmus paper is pressed against the hospital.
moist spatula. If the red litmus changes to 2. Reduce the risk of a delivery before arrival
blue, then liquor is present in the vagina, at the hospital or clinic.
6. PRETERM LABOUR AND PRETERM RUPTURE OF THE MEMBRANES 101
Infants born before 34 weeks are at increased 5-28 What are the contraindications to the
risk of developing complications. Therefore, use of salmotamol in suppressing labour?
suppression of contractions to allow
1. Heart valve disease. The use of salmutamol
continuation of pregnancy is important in
(or another beta2 stimulant), can endanger
these cases. The earlier the suppression of
the patient’s life, especially if she has a
contractions is started the better the chance of
narrowed heart valve, e.g. mitral stenosis.
successful suppression will be.
2. A shocked patient.
3. A patient with a tachycardia, e.g. as the
5-24 How would you decide that a patient result of an acute infection.
is less than 34 weeks pregnant if the
duration of the pregnancy is uknown?
5-29 What advice should you
This is done by measuring the symphysis- give to a woman who has
fundus height and by doing a complete delivered a preterm infant?
abdominal examination.
1. She should be seen at a level 2 hospital
Labour must be suppressed if the estimated before her next pregnancy to be assessed for
fetal weight is less than 2000 g as this suggests possible causes, e.g. cervical incompetence.
an estimated gestational age of less than 2. She must book early in any future
34 weeks. The symphysis-fundus height pregnancy.
measurement will be less than 33 cm.
5-25 How should you give nifedipine for CASE STUDY 1
the suppression of preterm labour?
Three nifedipine (Adalat) 10 mg capsules (total A patient, 32 weeks pregnant, presents with
30 mg) should be taken by mouth. If there regular painful uterine contractions. She
are still contractions with cervical dilatation is apyrexial and appears clinically well. On
and effacement 3 hours after the initial dose, a vaginal examination, the cervix is 4 cm dilated.
follow-up dose of 20 mg must be given. The fetal heart rate is 138 beats per minute
with no decelerations.
5-26 What are the contraindications to the
use of nifedipine in suppressing labour? 1. Is the patient in true or false labour?
Give the reasons for your diagnosis.
Nifedipine (Adalat) cannot be used for the
suppression of preterm labour if patients have She is in true labour because she is getting
hypertension, e.g. suffering from any of the regular painful contractions and her cervix is
hypertensive disorders of pregnancy. 4 cm dilated.
5-27 How should you use salmutamol 2. What signs exclude a diagnosis
for the suppression of preterm labour? of clinical chorioamnionitis?
1. A half an ampoule (0.5 ml = 250 μg) of The patient is apyrexial, clinically well and has
salbutamol (Ventolin) is diluted with 9.5 ml a normal fetal heart rate.
of sterile water in a 10 ml syringe and
administered slowly intravenously (0.5 ml 3. Why could chorioamnionitis still be
per minute) while the maternal heart rate is the cause of her preterm labour?
carefully monitored for a tachycardia. Because chorioamnionitis is often
2. The patient must be warned that salbutamol asymptomatic (subclinical chorio-amnionitis).
causes tachycardia (palpitations).
7. 102 PRIMAR Y MATERNAL CARE
4. Would you allow labour to continue 4. Is this patient at high risk of having
or would you suppress labour prior to or developing chorioamnionitis?
referring the patient to the hospital?
Yes. The preterm prelabour rupture of
Labour should be suppressed because the the membranes may have been caused by
pregnancy is of less than 34 weeks duration. chorioamnionitis. In addition, all patients with
ruptured membranes are at an increased risk
5. How should labour be suppressed? of developing chorioamnionitis.
Labour must be suppressed using nifedipine
5. Should the patient be referred to
(Adalat) or salbutamol (Ventolin).
a level I (district hospital/MOU) or
level II hospital? Give your reasons.
CASE STUDY 2 She is 36 weeks pregnant and there are no
signs of chorio-amnionitis. She should be
A patient, who is 36 weeks pregnant, reports referred to a level I hospital or MOU.
that she has been draining liquor since earlier
that day. The patient appears well, with normal
observations, no uterine contractions and the CASE STUDY 3
fetal heart rate is normal.
An unbooked patient presents at a primary
1. Would you diagnose rupture care clinic with a 5 day history of ruptured
of the membranes on the history membranes. She is pyrexial with lower
given by the patient? abdominal tenderness and is draining
offensive liquor. She is uncertain of her dates
No, other causes of fluid draining from the but abdominal examination suggests that she
vagina may cause confusion, e.g. a vaginitis or is at term. Treatment has been started with
stress incontinence. oral ampicillin.
2. How would you confirm 1. What signs of clinical chorioamnionitis
rupture of the membranes? does the patient have?
A sterile speculum examination should be She is pyrexial, with lower abdominal
done. If there is no clear evidence of liquor tenderness and she has offensive liquor.
draining, the vaginal pH must be determined
with Litmus paper to identify liquor.
2. How should the patient be managed?
3. Why should you not perform a digital There is danger of spreading infection in
vaginal examination to assess whether both the mother and fetus if the infant is not
the cervix is dilated or effaced? delivered. The patient must be referred to the
next level of care as an urgent case.
A digital vaginal examination is contra-
indicated in the presence of rupture of the
3. Is oral ampicillin the correct initial
membranes if the patient is not already in
treatment while waiting for the
labour, because of the risk of introducing
transfer? Give your reasons.
infection.
Chorioamnionitis may result in a severe
infection of the genital tract that may cause
a maternal death. These complications can
usually be prevented by starting broad-
spectrum antibiotics (ampicillin and
8. PRETERM LABOUR AND PRETERM RUPTURE OF THE MEMBRANES 103
metronidazole) as early as possible. The
ampicillin must be given intravenously.
4. Why is the infant at increased risk
for neonatal complications?
The chorioamnionitis has already spread to the
liquor as this is offensive. Therefore, the fetus
may also be infected and may present with
congenital pneumonia or septicaemia at birth.