產(chǎn)科學(xué)英文課件：10 PREMATURE RUPTURE OF MEMBRANE

1、PREMATURE RUPTURE OFMEMBRANE (PROM,Definition,PROM is rupture of membranes before the onset of labor Membrane rupture before labor and before 37 weeks of gestation is referred to as preterm PROM (PPROM) Incidence PROM: 5%15% of all delivery 10% of term pregnancy PPROM: 2%-3.5,Etiology,Vaginal infect

2、ion or intraamniotic infection: due to bacteria, virus, TOXO,CMV,HPV and HSV, et al Trauma (abdomen striked intensely): Sexual intercourse (in the late gestational weeks) ? Smoking Prior PROM or PPROM short cervical length Prior preterm delivery Bleeding in early pregnancy low body mass index,Affect

3、 on the mothers and infants,Mothers Infection: intraamniotic 1525%, postpartum 1520% Placental abruption: 25% of PPROM Preterm delivery Infants Preterm baby and their complications, (RDS / fetal and neurologic dysfunction, intracranial hemorrhage) Neonatal pneumonia, sepsis Pulmonary hypoplasia(發(fā)育不全

4、) and Respiratory distress: 1020% Prolapse or compression of cord Placental abruption,Clinical manifestation,Fluid pass through the vagina suddenly, and then small amounts of fluid flow through the vagina intermittently, particularly when the abdominal pressure increased (cough, sneeze et al) Infect

5、ion: fever, heart rate of mother andinfants , WBC and CRP , Uterinetenderness on palpation,Diagnosis,Sterile speculum examination amniotic fluid passing from the cervical canal and pooling in the vagina. Other findings: Cervicitis, umbilical cord prolapse or fetal prolapse, cervical dilatation and e

6、ffacement, obtain cultures PH determination of vaginal fluid: 6.5 The fern test (蕨形試驗) Ultrasonography: amniotic fluid volume Fetal fibronectin: sensitive, nonspecific Aminoscopy (羊膜鏡,Management,PROM at term Awaiting the onset of spontaneous labor for 12-24h: 50%, within 5 hours; 95%, within 28 hour

7、s. Termination of pregnancy after 24 hours ( without contraindications to labor): Induction of labor with oxytocin (at least 1218 hours) fetal heart rate monitoring Group B streptococcal prophylaxis: routine use,Management,PPROM Termination of pregnancy(1) Evidence of fetal pulmonary maturation(2) E

8、vidence of intrauterine infection Expectant therapy(1) Evidence of fetal pulmonary immaturation(2) Without evidence of intrauterine infection: culture for group B streptococci (GBS,Management,To enhance fetal pulmonary maturation 2434 weeks, A single course of corticosteroids (地塞米松), 5mg Q12h*4 34 weeks，intravenous MgSO4 (fetal neuroprotective treatment) Antibiotic 12 hours after membrane rupture 34 weeks (expectant), 7