ACOG PB139 Premature Rupture of Membranes Questions With 100% Correct Answers.

How common is preterm deliver in the USA? - 12% of all births How common is PROM? - 3% What is the main issue with management of PROM? - Prematurity vs Risk of Expectant Management (Infection, Abruption, Umbilical cord accident) Definition of PROM - Rupture of membranes before the onset of labor Definition of PPROM - Membrane rupture before labor and before 37 weeks of gestation What causes rupture of membranes? - Normal weakening of membranes, shearing forces from uterine contractions. Risk factors for PROM? - Intraamniotic infection, hx of PROM, Shortened cervix, 2nd/3rd trimester bleed, low BMI, low SES, Cigarette smoking, illicit drug use How often is PROM in term pregnancies? - 8%. Generally followed by onset of labor. Consequence of term PROM? - Intrauterine infection, increases with duration of membrane rupture How many patients deliver regardless of obstetric managment of PPROM? How many between 2-5 weeks? - 50%, 70-80% Latency after membrane rupture is _____ correlated with GA at time of PPROM. - InverselyClinically evident intraamniotic infection occurs in ____. Post partum infection occurs in _____. Incidence of infection is higher at _______. - 15-25% 15-20% Earlier GA Placental abruption occurs in ____ of PPROM. - 2-5% Most common issues/risks of prematurity? - Respiratory distress - most common Sepsis Intraventricular hemorrhage Necrotizing Enterocolitis PPROM w/ intrauterine inflammation has increased risk of what comorbidity? - Neurodevelopmental impairment. Early GA associated with increased risk of neonatal white matter damage. How often does PROM occur prior to viability? - 1% Maternal complications from previable PROM? - Intraamniotic infection, endometritis, abruptio placentae, retained placenta. Sepsis occurs 1% of time. How common is pulmonary hypoplasia after PROM before 24 weeks? - 10-20%. Rarely lethal with PROM subsequent to 23-24 weeks. What fetal issues are associated with prolonged oligohydramnios? - Potter-like facies (low set ears, epicanthal folds) and limb contractures. How to diagnose PPROM? - History and Physical Exam for Pooling/Valsalva/Fern, Amnisure, pH test. US for AFI. If still unclear, US guided transabdominal instillation of indigo carmine dye.Should digital cervical exam be performed? - SVE only increases the risk of infection and add little information available with speculum exam. Therefore they should be avoided unless they appear in labor. Initial managment of PROM - Assess GA, fetal presentation and status. R/U infection, abruptio placentae and fetal compromise. Collect GBS Management of PROM at term - Start GBS prophylaxis if indicated and start induction Prostiglandin is equally effctive as pitocin but has increased risk of infection. Infection also more common with mechanical (foley) dilation How long do you wait with adequate contractions before considering C Section? - 12-18 hrs. When is delivery of pre-term fetus recommended with PROM? - NRFHT, Chorio, abrupio placenta How to manage Preterm PROM? - <34 wks, Expectant managment up to 37w0d, Mercer antibiotics, Corticosteroids (BMZ), MgSO4 for neuroprotection