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Premature rupture of membranes

This is a brief video on premature rupture of membranes, or the leakage of amniotic fluid before labor. I created this presentation with Google Slides. Images were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS: Premature rupture of membranes 10-week-old human fetus surrounded by amniotic fluid and fetal membranes By drsuparna http://www.flickr.com/photos/74896762... - http://www.flickr.com/photos/74896762..., CC BY-SA 2.0, https://commons.wikimedia.org/w/index... Leakage of amniotic fluid before labor Overview Risk factors and causes Diagnosis Management Chorio- amnionitis PROM = premature rupture of membranes Amniotic sac rupture / fluid spillage more than one hour before onset of labor Labor = regular contractions + cervical change PPROM = preterm premature rupture of membranes Amniotic sac rupture before 37 weeks Prolonged rupture of membranes Amniotic sac rupture for longer than 18 hours before delivery “Gush of fluid†vs steady leakage of fluid Note color and consistency of fluid Thick vs watery Clear, cloudy, meconium, blood-tinged Overview Overview Risk factors and causes Diagnosis Management Chorio- amnionitis Vaginal or cervical infections: UTIs, STIs, bacterial vaginosis Smoking or drug use during pregnancy PROM or preterm deliveries in previous pregnancies Nutritional deficiencies; underweight mothers Polyhydramnios (too much amniotic fluid) Multiple gestation Cervical insufficiency (short or prematurely dilated cervix) Invasive procedures (amniocentesis, cerclage, etc) Pathophysiology: Weak fetal membranes Infections (sometimes subclinical) Genetics Risk factors and causes Overview Risk factors and causes Diagnosis Management Chorio- amnionitis Three classic tests Pooling: Collection of fluid in the vagina (posterior fornix) Nitrazine: Neutral fluid turns nitrazine paper blue; vaginal fluid usually acidic. Amniotic fluid is mildly acidic → blue nitrazine paper False positives: blood, semen, infections, antiseptics, lubricant Ferning: Dry amniotic fluid on glass slide has crystallization pattern called arborization that resembles fern plant on light microscopy Ultrasound can detect low levels of fluid (low residual fluid levels) Other new tests detect chemicals or proteins in amniotic fluid By Paul_012 - originally posted to Flickr as Positive fern test, CC BY-SA 2.0, https://commons.wikimedia.org/w/index... Management Overview Risk factors and causes Diagnosis Management Chorio- amnionitis Previable 24 weeks Watchful waiting; no tocolytics, steroids, MgSO4, or abx Induction of labor to end pregnancy Preterm 24-33 weeks Tocolytics to prevent labor; steroids twice 24 hrs apart for lung maturity; MgSO4 as tocolytic while lungs mature; abx for GBS prevention Amnioinfusion to replace lost fluid is controversial Late preterm 34-36 weeks Induce labor; abx for GBS prevention Term 37 weeks Induce labor; abx for GBS prevention Definition: infection of chorion, amnion, and/or amniotic fluid surrounding fetus Diagnosis: Signs and symptoms: fever, rupture of membranes, leakage of fluid, uterine tenderness, elevated maternal heart rate ( 100 bpm), elevated fetal heart rate (160 bpm) Fever: exclude maternal URI and UTI Labs: increased white count ( 15,000 cells/mm³) Treat with ampicillin, gentamicin, and clindamycin Induce delivery Covers gram negatives and anaerobes Afebrile for 24 hours Chorioamnionitis Overview Risk factors and causes Diagnosis Management Chorio- amnionitis By Nephron - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index...