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Premature rupture of membrane, case and Topic ll Dr.Jakia Akter

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Mrs. Shorifa, 30 years, para 1+0, housewife of middle socioeconomic family, hailing from Keraniganj, Dhaka, got herself admitted in our hospital on 28.08.16, with the complaints of amenorrhoea for 36+ weeks and pervaginal watery discharge for 6 hours. According to the statement of the patient, she was a regularly menstruating woman with a menstrual cycle of 28 to 30 days, then she developed amenorrhoea and her pregnancy was confirmed by strip test. Her LMP was 13th December, 2015 and accordingly her EDD will be 20th September which was also dated by early USG. She was on regular ANC and completed her doses of TT vaccination. Her ante natal period was uneventful upto 36 weeks of pregnancy but for last 6 hours she noticed sudden gush of pervaginal watery discharge while standing from supine position. It was moderate in amount, clear, non-odourous, gradually decreased but continued while taking rest & was incresaing with movement & change of posture.

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Welcome Presented by Dr .Jakia Akter Sir Salimullah Medical College
Case Name Premature Rupture of Membrane PROM
Salient Features Mrs. Shorifa, 30 years, para 1+0, housewife of middle socioeconomic family, hailing from Keraniganj, Dhaka, got herself admitted in our hospital on 28.08.16, with the complaints of amenorrhoea for 36+ weeks and pervaginal watery discharge for 6 hours. According to the statement of the patient, she was a regularly menstruating woman with a menstrual cycle of 28 to 30 days, then she developed amenorrhoea and her pregnancy was confirmed by strip test. Her LMP was 13th December, 2015 and accordingly her EDD will be 20th September which was also dated by early USG. She was on regular ANC and completed her doses of TT vaccination. Her ante natal period was uneventful upto 36 weeks of pregnancy but for last 6 hours she noticed sudden gush of pervaginal watery discharge while standing from supine position. It was moderate in amount, clear, non-odourous, gradually decreased but continued while taking rest & was incresaing with movement & change of posture.
Contd.. It was not associated with LAP or itching in the genital area. She gave no H/O fever or frequency of micturition. She had no such experience in her previous pregnancy & no H/O trauma. She used OCP for contraception. She has no H/O of asthma, TB, DM, or any other medical illness. She is normotensive. Her B/B habit is normal.
Clinical Examination: A. General Exam: Co-operative, avg. ht & body built Pulse-72 bpm BP-110/70 mm Hg Temp-N Anaemia-mild Edema-absent LN-not enlarged Thyroid gland-not enlarged B. Breast exam: Normal pregnancy changes
C. Per-abdominal exam: SFH-36 cm Abdominal girth-92 cm Lie-longitudinal Presentation-cephalic Rule of 5th-4/5th palpable FHR-138 bpm &regular Contd..
Per-vaginal Exam a) Inspection: 1. Vulva pad was soaked with watery discharge 2. Characteristics of discharge: a. Clear b. Not foul smelling 3. Vulva & perineum: Normal
b) Per-speculum Exam 1. Liquor was escaping out through external Os. 2. Os closed. 3.No cord prolapse. Contd..
SYSTEMIC EXAMINATION No abnormality was detected in Cardio- Respiratory & Nervous System.
Differential Diagnosis 1) PROM 2) Hydrorrhea Gravidarun 3) Incontinence Of Urine
Investigations CBC:Hb%-9.2 gm/dl WBC-9312/mm Urine R/E & C/S: Normal HVS: USG:
Clinical Diagnosis 2ND Gravida 36+ weeks pregnancy with PROM
Topic Presentation Premature Rupture of Membrane PROM
Definition Spontaneous rupture of the membranes any time beyond 28th weeks of pregnancy but before the onset of labour is called PROM.
Types Two types: 1.Preterm Term: When rupture of membrane occurs before 37 completed wks is called preterm PROM. 2.Term PROM: When rupture of membrane occurs beyond 37th wks but before the onset of labour called Term PROM.
Incidence Approximately 10% of all pregnancies
Causes Increased friability of the membrane Decreased tensile strength of the membranes Polyhydramnios Cervical incompetence Multiple pregnancy Infection
Investigation CBC Urine R/E & C/S High vaginal swab for C/S USG for fetal biophysical profile
Confirmation of diagnosis Examination of collected fiuid from post. Fornix: a.Fern Tests b.Nile Blue sulphate Test c.Litmus Test or Nitrazine Paper Test for detection of pH.
Complication Preterm labour & prematurity Chance of asceding infection Cord prolapse Dry labour Placental abruption Neonatal sepsis,RDS,IVH Perinatal Morbidities
Management
Premature rupture of membrane, case and Topic ll Dr.Jakia Akter

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Premature rupture of membrane, case and Topic ll Dr.Jakia Akter

  • 1. Welcome Presented by Dr .Jakia Akter Sir Salimullah Medical College
  • 2. Case Name Premature Rupture of Membrane PROM
  • 3. Salient Features Mrs. Shorifa, 30 years, para 1+0, housewife of middle socioeconomic family, hailing from Keraniganj, Dhaka, got herself admitted in our hospital on 28.08.16, with the complaints of amenorrhoea for 36+ weeks and pervaginal watery discharge for 6 hours. According to the statement of the patient, she was a regularly menstruating woman with a menstrual cycle of 28 to 30 days, then she developed amenorrhoea and her pregnancy was confirmed by strip test. Her LMP was 13th December, 2015 and accordingly her EDD will be 20th September which was also dated by early USG. She was on regular ANC and completed her doses of TT vaccination. Her ante natal period was uneventful upto 36 weeks of pregnancy but for last 6 hours she noticed sudden gush of pervaginal watery discharge while standing from supine position. It was moderate in amount, clear, non-odourous, gradually decreased but continued while taking rest & was incresaing with movement & change of posture.
  • 4. Contd.. It was not associated with LAP or itching in the genital area. She gave no H/O fever or frequency of micturition. She had no such experience in her previous pregnancy & no H/O trauma. She used OCP for contraception. She has no H/O of asthma, TB, DM, or any other medical illness. She is normotensive. Her B/B habit is normal.
  • 5. Clinical Examination: A. General Exam: Co-operative, avg. ht & body built Pulse-72 bpm BP-110/70 mm Hg Temp-N Anaemia-mild Edema-absent LN-not enlarged Thyroid gland-not enlarged B. Breast exam: Normal pregnancy changes
  • 6. C. Per-abdominal exam: SFH-36 cm Abdominal girth-92 cm Lie-longitudinal Presentation-cephalic Rule of 5th-4/5th palpable FHR-138 bpm &regular Contd..
  • 7. Per-vaginal Exam a) Inspection: 1. Vulva pad was soaked with watery discharge 2. Characteristics of discharge: a. Clear b. Not foul smelling 3. Vulva & perineum: Normal
  • 8. b) Per-speculum Exam 1. Liquor was escaping out through external Os. 2. Os closed. 3.No cord prolapse. Contd..
  • 9. SYSTEMIC EXAMINATION No abnormality was detected in Cardio- Respiratory & Nervous System.
  • 10. Differential Diagnosis 1) PROM 2) Hydrorrhea Gravidarun 3) Incontinence Of Urine
  • 12. Clinical Diagnosis 2ND Gravida 36+ weeks pregnancy with PROM
  • 14. Definition Spontaneous rupture of the membranes any time beyond 28th weeks of pregnancy but before the onset of labour is called PROM.
  • 15. Types Two types: 1.Preterm Term: When rupture of membrane occurs before 37 completed wks is called preterm PROM. 2.Term PROM: When rupture of membrane occurs beyond 37th wks but before the onset of labour called Term PROM.
  • 17. Causes Increased friability of the membrane Decreased tensile strength of the membranes Polyhydramnios Cervical incompetence Multiple pregnancy Infection
  • 18. Investigation CBC Urine R/E & C/S High vaginal swab for C/S USG for fetal biophysical profile
  • 19. Confirmation of diagnosis Examination of collected fiuid from post. Fornix: a.Fern Tests b.Nile Blue sulphate Test c.Litmus Test or Nitrazine Paper Test for detection of pH.
  • 20. Complication Preterm labour & prematurity Chance of asceding infection Cord prolapse Dry labour Placental abruption Neonatal sepsis,RDS,IVH Perinatal Morbidities