{"id":220,"date":"2020-08-13T16:28:11","date_gmt":"2020-08-13T16:28:11","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=220"},"modified":"2023-09-30T10:33:18","modified_gmt":"2023-09-30T10:33:18","slug":"25-premature-rupture-of-membranes","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/basic_obgyn\/overview\/25-premature-rupture-of-membranes\/","title":{"rendered":"25. Premature ROM"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/e6YLras5ndg\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 7:16<\/p>\n<input type='hidden' bg_collapse_expand='69e9eec42a3bf2030455667' value='69e9eec42a3bf2030455667'><input type='hidden' id='bg-show-more-text-69e9eec42a3bf2030455667' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9eec42a3bf2030455667' value='Hide Transcript'><button id='bg-showmore-action-69e9eec42a3bf2030455667' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9eec42a3bf2030455667' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 25<br \/>\n00:02<br \/>\npremature rupture of membranes amniotic<br \/>\n00:05<br \/>\nfluid starts to be continuously produced<br \/>\n00:07<br \/>\nat approximately 16 weeks gestation<br \/>\n00:09<br \/>\nremember that it is primarily dependent<br \/>\n00:11<br \/>\non fetal urine production amniotic fluid<br \/>\n00:15<br \/>\nallows for fetal movement in breathing<br \/>\n00:16<br \/>\nwhich are important for fetal skeletal<br \/>\n00:18<br \/>\nlung and chest development decreased or<br \/>\n00:21<br \/>\nabsent amniotic fluid can lead to<br \/>\n00:23<br \/>\ncompression of the umbilical cord and<br \/>\n00:25<br \/>\ndecrease placental flow disruption of<br \/>\n00:27<br \/>\nthe fetal membranes leads to a loss of<br \/>\n00:29<br \/>\nthese protective effects and the<br \/>\n00:30<br \/>\ndevelopmental roles of amniotic fluid<br \/>\n00:32<br \/>\nthe objectives of this video are to list<br \/>\n00:35<br \/>\nthe history physical findings and<br \/>\n00:36<br \/>\ndiagnostic methods to confirm rupture of<br \/>\n00:38<br \/>\nmembranes identify risk factors for<br \/>\n00:41<br \/>\npremature rupture of membranes describe<br \/>\n00:43<br \/>\nthe risks and benefits of expectant<br \/>\n00:45<br \/>\nmanagement versus immediate delivery<br \/>\n00:46<br \/>\nbased on gestational age and finally<br \/>\n00:49<br \/>\ndescribe the methods to monitor maternal<br \/>\n00:51<br \/>\nand fetal status during expectant<br \/>\n00:53<br \/>\nmanagement prom is premature rupture of<br \/>\n00:56<br \/>\nmembranes before the onset of labor P<br \/>\n00:59<br \/>\nprom is preterm premature rupture of<br \/>\n01:01<br \/>\nmembranes occurring before 37 weeks<br \/>\n01:03<br \/>\nestimated gestational age this is a<br \/>\n01:05<br \/>\nleading cause of neonatal morbidity and<br \/>\n01:07<br \/>\nmortality and is associated with 30% of<br \/>\n01:09<br \/>\npreterm deliveries the consequences of P<br \/>\n01:12<br \/>\nprom depend on the gestational age at<br \/>\n01:14<br \/>\nthe time of occurrence persistent<br \/>\n01:16<br \/>\nillegal head Romano&#8217;s at less than<br \/>\n01:18<br \/>\ntwenty two weeks SMA gestational age<br \/>\n01:20<br \/>\nleads to incomplete fetal alveolar<br \/>\n01:22<br \/>\ndevelopment and the development of<br \/>\n01:23<br \/>\npulmonary hypoplasia infants born with a<br \/>\n01:25<br \/>\npulmonary hypoplasia cannot be<br \/>\n01:27<br \/>\nadequately ventilated when P prom occurs<br \/>\n01:30<br \/>\nbetween 24 and 26 weeks there is likely<br \/>\n01:32<br \/>\nto be survival however there will be<br \/>\n01:34<br \/>\npossible substantial morbidities from<br \/>\n01:36<br \/>\nextreme prematurity what are risk<br \/>\n01:38<br \/>\nfactors for prom anything that weakens<br \/>\n01:40<br \/>\nthe strength of the Chorio amniotic<br \/>\n01:42<br \/>\nmembrane here is the uterus here is the<br \/>\n01:45<br \/>\ncervix and this is the Koryo amniotic<br \/>\n01:50<br \/>\nmembrane and a sending infection from<br \/>\n01:54<br \/>\nthe vagina will weaken these membranes<br \/>\n02:00<br \/>\nso sexually transmitted infections and<br \/>\n02:02<br \/>\nother lower genital tract infections<br \/>\n02:04<br \/>\nsuch as bacterial vaginosis play a role<br \/>\n02:06<br \/>\nas risk factors this can be one reason<br \/>\n02:08<br \/>\nwhy a short cervix is also a risk factor<br \/>\n02:10<br \/>\nfor prom the risk for prom is also<br \/>\n02:12<br \/>\ndoubled for women who<br \/>\n02:13<br \/>\nSmok other risk factors include a<br \/>\n02:16<br \/>\nhistory of prior prom polyhydramnios and<br \/>\n02:19<br \/>\nmultiple gestation x&#8217; will basically<br \/>\n02:22<br \/>\ndescend the Chorio amniotic membranes<br \/>\n02:24<br \/>\nother risk factors are similar to risk<br \/>\n02:26<br \/>\nfactors for preterm delivery including a<br \/>\n02:28<br \/>\nprior preterm delivery bleeding during<br \/>\n02:30<br \/>\npregnancy low socioeconomic status and<br \/>\n02:33<br \/>\nlow body mass index it is very important<br \/>\n02:37<br \/>\nto be able to accurately diagnose when a<br \/>\n02:39<br \/>\npatient has had rupture of her membranes<br \/>\n02:41<br \/>\npatients may describe an obvious gush of<br \/>\n02:43<br \/>\nfluid or they may describe a study<br \/>\n02:45<br \/>\nleakage of small amounts of fluid it can<br \/>\n02:48<br \/>\nbe confusing for during pregnancy there<br \/>\n02:50<br \/>\nare many things that can mimic amniotic<br \/>\n02:52<br \/>\nfluid<br \/>\n02:52<br \/>\nit could be urine normal vaginal<br \/>\n02:54<br \/>\nsecretions of pregnancy increased<br \/>\n02:56<br \/>\ncervical discharge semen or just<br \/>\n02:58<br \/>\nperineal sweat for the physical exam a<br \/>\n03:01<br \/>\nsterile speculum examination should be<br \/>\n03:03<br \/>\nperformed to visually assess the cervix<br \/>\n03:04<br \/>\nand to swab for cervical gonorrhea and<br \/>\n03:06<br \/>\nchlamydia a group B strep culture should<br \/>\n03:09<br \/>\nbe obtained as well<br \/>\n03:09<br \/>\nan ultrasound should be performed to<br \/>\n03:12<br \/>\nassess fetal position as well as to<br \/>\n03:14<br \/>\nassess the amount of amniotic fluid<br \/>\n03:15<br \/>\nremember to minimize digital cervical<br \/>\n03:18<br \/>\nexaminations to decrease the risk of<br \/>\n03:19<br \/>\ninfection for diagnostic testing nitrous<br \/>\n03:22<br \/>\nand paper is used for amniotic fluid is<br \/>\n03:25<br \/>\nalkaline with a pH greater than seven<br \/>\n03:26<br \/>\npoint one and vaginal secretions have a<br \/>\n03:29<br \/>\npH between four point five to six so<br \/>\n03:31<br \/>\namniotic fluid will appear blue on<br \/>\n03:33<br \/>\nnitrazine paper burning refers to the<br \/>\n03:35<br \/>\npattern of arborization when amniotic<br \/>\n03:37<br \/>\nfluid is placed on a slide and is<br \/>\n03:39<br \/>\nallowed to dry and finally pooling<br \/>\n03:41<br \/>\nrefers to the filling of the speculum<br \/>\n03:43<br \/>\nwith amniotic fluid once we have<br \/>\n03:45<br \/>\nconfirmed that rupture of membranes has<br \/>\n03:47<br \/>\noccurred then we need to move on to<br \/>\n03:48<br \/>\nmanagement how do we decide an expectant<br \/>\n03:50<br \/>\nmanagement versus immediate delivery the<br \/>\n03:53<br \/>\npatient&#8217;s just a tional age presence of<br \/>\n03:55<br \/>\nclinical infection placental abruption<br \/>\n03:57<br \/>\nlabor and fetal status all have to be<br \/>\n03:59<br \/>\ntaken into account if the patient is<br \/>\n04:02<br \/>\nterm greater than 37 weeks approximately<br \/>\n04:04<br \/>\n90% of patients will go into spontaneous<br \/>\n04:06<br \/>\nlabor within 24 hours labor should be<br \/>\n04:09<br \/>\ninduced either at the time of<br \/>\n04:11<br \/>\npresentation or the patient can be<br \/>\n04:12<br \/>\nexpectantly managed induction of labour<br \/>\n04:15<br \/>\nreduces the time to delivery and the<br \/>\n04:17<br \/>\nrates of chorioamnionitis endometritis<br \/>\n04:18<br \/>\nand admission to the neonatal intensive<br \/>\n04:20<br \/>\ncare unit if the patient does not go<br \/>\n04:22<br \/>\ninto spontaneous labor on her own then<br \/>\n04:24<br \/>\nlabor induction should be performed with<br \/>\n04:26<br \/>\noxytocin<br \/>\n04:27<br \/>\nfor patients who are preterm or less<br \/>\n04:29<br \/>\nthan 37 weeks the risks of uterine<br \/>\n04:31<br \/>\ninfection versus the risks of<br \/>\n04:33<br \/>\nprematurity need to be weighed carefully<br \/>\n04:35<br \/>\nfor late preterm patients from 34 to 36<br \/>\n04:39<br \/>\nweeks and six days estimate gestational<br \/>\n04:41<br \/>\nage the management is the same as term<br \/>\n04:43<br \/>\nfor the risks of infection outweigh the<br \/>\n04:45<br \/>\nrisks of prematurity an induction of<br \/>\n04:48<br \/>\nlabour is started for these patients<br \/>\n04:49<br \/>\nonce rupture of membranes is confirmed<br \/>\n04:51<br \/>\nif the fetus is breached then a<br \/>\n04:53<br \/>\ncaesarean section will have to be<br \/>\n04:54<br \/>\nperformed if pea prom occurs between 24<br \/>\n04:57<br \/>\nweeks and 33 and 6 the risk of fetal<br \/>\n05:00<br \/>\nlung maturity from prematurity is very<br \/>\n05:02<br \/>\nhigh thus it is important to administer<br \/>\n05:04<br \/>\ncorticosteroids which enhance fetal<br \/>\n05:06<br \/>\npulmonary maturity antibiotics are<br \/>\n05:09<br \/>\nadministered to increase the latency<br \/>\n05:10<br \/>\nperiod which is the time between rupture<br \/>\n05:12<br \/>\nof membranes and spontaneous labor note<br \/>\n05:15<br \/>\nthis important point antibiotics are<br \/>\n05:17<br \/>\nadministered because they have been<br \/>\n05:18<br \/>\nshown to increase the amount of time<br \/>\n05:19<br \/>\nbefore spontaneous labor the antibiotics<br \/>\n05:22<br \/>\nare not to treat an infection if there<br \/>\n05:24<br \/>\nis an infection present diagnosed by<br \/>\n05:26<br \/>\nuterine tenderness fevers and\/or<br \/>\n05:28<br \/>\nincreased white blood cell count then<br \/>\n05:29<br \/>\ndelivery needs to be initiated assuming<br \/>\n05:33<br \/>\nthat there is no evidence of uterine<br \/>\n05:34<br \/>\ninfection a patient with pea prom from<br \/>\n05:36<br \/>\n24 to 33 and 6 estimated gestational age<br \/>\n05:39<br \/>\nwill be admitted for inpatient<br \/>\n05:41<br \/>\nhospitalization with ultrasounds to<br \/>\n05:43<br \/>\nassess amniotic fluid volume and<br \/>\n05:44<br \/>\nantepartum testing such as non stress<br \/>\n05:47<br \/>\ntests delivery will be induced between<br \/>\n05:50<br \/>\n32 and 34 weeks<br \/>\n05:51<br \/>\nremember again however if the patient<br \/>\n05:53<br \/>\ndevelops evidence of uterine infection<br \/>\n05:55<br \/>\nthen delivery will be immediately<br \/>\n05:57<br \/>\ninitiated pre viable pea prom is rare<br \/>\n06:00<br \/>\noccurring in less than 1% of pregnancies<br \/>\n06:02<br \/>\nthere are important risks of prematurity<br \/>\n06:04<br \/>\nto discuss with this population<br \/>\n06:06<br \/>\npulmonary hypoplasia rates are<br \/>\n06:08<br \/>\napproximately 10 to 20 percent and<br \/>\n06:10<br \/>\nprolonged oligo hydrea nails can cause<br \/>\n06:12<br \/>\nfetal deformations and limb contractures<br \/>\n06:14<br \/>\nbecause the fetus cannot move freely<br \/>\n06:16<br \/>\nwithin the amniotic sac neonatal death<br \/>\n06:19<br \/>\nand morbidity rates decrease with a<br \/>\n06:21<br \/>\nlonger latency period and advancing<br \/>\n06:23<br \/>\ngestational age there are also<br \/>\n06:25<br \/>\nsignificant maternal complications that<br \/>\n06:27<br \/>\ncan occur with prolonged rupture of<br \/>\n06:28<br \/>\nmembranes with increased risks of<br \/>\n06:30<br \/>\nsystemic infections the management for<br \/>\n06:32<br \/>\npatients with pre viable pea prom<br \/>\n06:34<br \/>\ninvolves patient counseling and<br \/>\n06:35<br \/>\nexpectant management or induction of<br \/>\n06:38<br \/>\nlabour antibiotics and corticosteroids<br \/>\n06:40<br \/>\nare not rare<br \/>\n06:41<br \/>\nbefore viability this concludes the<br \/>\n06:44<br \/>\naapko video on prom we have reviewed<br \/>\n06:46<br \/>\nrisk factors diagnosis and management<br \/>\n06:48<br \/>\nfor this common obstetric condition<br \/>\n06:50<br \/>\nremember that management depends on<br \/>\n06:52<br \/>\ngestational age and always consider the<br \/>\n06:54<br \/>\nrisks of uterine infection versus the<br \/>\n06:56<br \/>\nrisks and prematurity<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 7:16<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":46,"menu_order":25,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-220","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/220","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/comments?post=220"}],"version-history":[{"count":5,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/220\/revisions"}],"predecessor-version":[{"id":1280,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/220\/revisions\/1280"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/basic_obgyn\/wp-json\/wp\/v2\/media?parent=220"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}