Lectures

Premature Rupture of Membranes (PROM)

by Veronica Gillispie, MD, FACOG
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    Now let's discuss preterm premature rupture of membranes. First let's go with some definitions. Preterm rupture of membranes means rupture of membranes that happens before 37 weeks of gestation. Premature rupture of membranes means rupture of membranes that happens before the onset of labor. So there are some key issues to address. The first is to confirm rupture of membranes. So there are four ways that we confirm rupture of membranes. Then we're going to talk about which one of these is the best. So the nitrazine test. This is similar to litmus paper. So litmus paper and nitrazine paper is placed inside the vagina and we expect it to change color because of the PH of amniotic fluid. The thing that you need to know however, is that the litmus paper or the nitrazine paper will also change colors because of infections with bacterial vaginosis, blood and semen. So this cannot be used by itself to determine if a patient has rupture of membranes. Another test we can do to confirm the rupture of membranes is the ferning test. To perform this test we take a small amount of fluid that we see in the vagina that we expect to be amniotic fluid. Place it on a slide. Allow it to dry. And we look under the microscope. This is an example of ferning. This is kind of what we would see for a patient that has rupture of membranes. But as the slide indicates there other things that can cause feming such as cervical mucus. So again ferning should be used along to confirm rupture of membranes. Another test we can do is pooling. To do the pooling test we place a speculum inside the vagina. And we ask for the mom to cough or to bare down....

    About the Lecture

    The lecture Premature Rupture of Membranes (PROM) by Veronica Gillispie, MD, FACOG is from the course Antenatal Care. It contains the following chapters:

    • Preterm Premature Rupture of Membranes
    • Overview Based on Gestational Age – Considerations

    Included Quiz Questions

    1. Pooling of amniotic fluid on speculum exam with valsalva
    2. Ferning of suspected amniotic fluid seen under a microscope
    3. Nitrazine paper or swab changing color when placed in the vagina
    4. Maximum vertical pocket less than 2cm on ultrasound
    5. Reported history of a large gush of fluid
    1. Candidal vaginitis
    2. Amniotic fluid
    3. Bacterial vaginosis
    4. Blood
    5. Semen
    1. If she has a positive group B streptococcus culture in urine or screening rectovaginal swab
    2. If she has an unknown group B streptococcus status
    3. If her membranes have been ruptured for over 4 hours prior to onset of labor
    4. If she has a group B streptococcus rectovaginal screening swab done prior to 35 weeks gestational age
    5. If she has a negative group B streptococcus rectovaginal screening swab
    1. Increases lung surfactant production and alveolar recruitment
    2. Increases latency period to prevent delivery before 34 weeks
    3. Increases fetal risk for intraventricular hemorrhage
    4. Increases fetal risk for nectrotizing enterocoloitis
    5. Provides neuroprotection against cerebral palsy
    1. If preterm rupture of membranes is between 24 weeks and 33 weeks and 6 days gestational age
    2. If preterm rupture of membranes is before 24 weeks gestational age
    3. If preterm rupture of membranes is anytime prior to 37 weeks gestational age
    4. If preterm rupture of membranes is in a mother who is allergic to steroids and needs alternate treatment for fetal lung maturity
    5. If preterm rupture of membranes is prolonged to avoid chorioamnionitis
    1. In the case of preterm premature rupture of membranes prior to 34 weeks gestational for up to 48 hours to allow administration of steroids
    2. In the case of chorioamnionitis in preterm premature rupture of membranes
    3. In the case of preterm premature rupture of membranes between 34 weeks to 36 weeks 6 days gestational age
    4. In the case of preterm premature rupture of membranes to a mom who is GBS positive to allow administration of antibiotics
    5. In the case of preterm premature rupture of membranes prior to 24 weeks gestational age

    Author of lecture Premature Rupture of Membranes (PROM)

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG


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