Preterm Premature Rupture of the Membranes By Dr. maysoon sharief

Definition Rupture of the fetal membranes prior to the completion of the 37th week of pregnancy Complicates 1/3 of all preterm deliveries Around 1-2% of pregnancies Majority of patients delivery within 1 week

ETIOLOGY AND PATHOGENESIS 1-polyhydramnios 2-multiple pregnancy 3- cervical incompetence 4-ascending genital infection

DIAGNOSIS 1-visualization of amniotic fluid in the vagina 2-nitrazine test :PH is normally 4.5-5.5, amniotic fluid has a PH of 7 to 7.5 the paper change to blue in alkaline PH 3- fern test 5-evaporation test 6-ultrasound examination 7-intaamniotic fluorescein 8-amnioscopy 9-fetal fibronectin 10-alfa-fetoprotien test

Matrenal and fetal complication 1-chorioamniotic infection 4.2%- 10.5% DIAGNOSIS: fever,matrenal tachycardia,fetal tachycardia,uterine tenderness, foul odor of amniotic fluid,matrenal leukocytosis lab test:WBC,C-reactive protin,Gram stain of amniotic fluid ,most causative organism is group B steptococci,E.coli,ureaplasma urealyticum,mycoplasma hominis, leukocyte esterase assay 2-Hyaline membrane disease 3-pulmonary hypoplasia 4-abruptio placentae 5-fetal distress 6-fetal deformities

MANAGEMENT Identificaton of patient who require delivery 1-patient in labour 2-patient with mature fetal lung 3-patient with fetal malformation 4- patient with fetal distress 5- patient with overt infection In all those patients should be deliver regardless of gestational age EXPECTANT MANAGEMENT

Management Expectatent 1- bed rest 2- daily checking of Temp.,Bp, pulse rate, uterine contraction, offensive vaginal discharge 3-prophylactic antibiotics 4-tocolytic agent 5-corticosteroid like dexamethasone 8mg\12 hs for 48hs 6-termination of pregnancy at any time infection take place

Management Frank discussion with parents with mid-trimester PPROM Some studies suggest that these patients do well if there is some fluid and pregnancy can be prolonged until after 26 weeks Expectant management is permissible as long as there are no contraindications