产科学英文课件：10 PREMATURE RUPTURE OF MEMBRANE.ppt

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 infection 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 on the mothers and infants Mothers Infection: intraamniotic 15–25%, postpartum 15–20% Placental abruption: 2–5% of PPROM Preterm delivery Infants Preterm baby and their complications, (RDS / fetal and neurologic dysfunction, intracranial hemorrhage) Neonatal pneumonia, sepsis Pulmonary hypoplasia(发育不全) and Respiratory distress: 10–20% 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) Infection: 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 effacement, obtain cultures PH determination of vaginal fluid: ≥6.5 The fern test (蕨形试验) Ultrasonography: amniotic fluid volume Fetal fibronectin: sensitive, nonspecific Aminoscopy (羊膜镜) Management PROM at term Awaiting the onset of spontaneous labor for 12-24h: 50%, within 5 hours; 95%, within 28 hours. Termination of pregnancy after 24 hours ( without contraindications to labor): Induction of labor with oxytocin (at least 12–18 hours) fetal heart rate monito