Background
Clinical condition associated with premature rupture of membranes, particularly at earlier gestational ages
What is intraamniotic infection?
What findings on speculum examination are suggestive of prelabor rupture of membranes (3)?
Pooling of fluid/visualization of fluid coming from the cervical os
Positive ferning on dry mount
Positive nitrazine test
The presence of this clinical condition is a contraindication to expectant management at any gestational age.
What is intraamniotic infection?
According to ACOG, outpatient, home management of prelabor rupture of membranes may be considered in this circumstance.
Given risks of acute infection, labor, and cord compression, inpatient management is recommended after reaching viability.
These criteria must be visualized in order to confirm adequate imaging of the fetal facial profile (3/5).
What are the tip of the nose, the nasal bone, the maxilla, and the mandible, seen in a true midsagittal plane?
The major obstetric complications resulting from premature rupture of membranes (3/5)
What are: infection, placental abruption, umbilical cord accidents, and preterm birth (or maternal or fetal death as a result of any of the aforementioned causes)?
This test is a sensitive but nonspecific test for rupture of membranes.
What is fetal fibronectin?
A negative test rules out membrane rupture but positive test does not confirm diagnosis.
This treatment is associated with an increased latency period and reduced rate of preterm birth in the first 48 hours after PROM, as well as an increased risk of intrauterine infection in pregnancies less than 34 weeks gestation.
What is tocolytic therapy?
Cerclage retention may be considered after prelabor rupture of membranes if these criteria are met (2).
What are absence of infection or active labor?
Absence of this structure, normally seen on the facial profile, is associated with an increased risk of T21.
What is the nasal bone?
Risk factors associated with prelabor rupture of membranes (4/7)
H/o PTB
Short cervix
2nd or 3rd trimester bleeding
Low BMI
Low socioeconomic status
Smoking
Illicit drug use
The pH ranges of vaginal secretions and amniotic fluid respectively.
What are 3.8-4.5 and 7.1-7.3?
GBS prophylaxis, antenatal corticosteroids, tocolytic therapy, and magnesium are not recommended for cases of prelabor rupture of membranes prior to this gestational age.
What is 24 weeks gestation?
Latency antibiotics may be considered as early as 20 weeks gestation.
These three factors are associated with lower rates of vertical transmission of HSV in the setting of prelabor rupture of membranes.
What are treatment with acyclovir, cesarean for active genital lesions, and recurrent (rather than primary) lesions?
A defect greater than 1.5mm seen in this strucure, seen on the facial profile, should prompt evaluation for facial clefts.
What is the maxilla?
Rates of prelabor rupture of membranes in the preterm and term populations.
What are 2-3% and 8%?
In equivocal cases, this invasive procedure may be used to confirm the diagnosis of prelabor rupture of membranes.
What is an amnio dye test?
This antibiotic is associated with increased risks of NEC and is not recommended for prolonging the latency period after membrane rupture.
What is Augmentin (amoxicillin-clavulanic acid)?
These three factors may reduce the risk of vertical transmission of HIV in the setting of prelabor rupture of membranes.
What are treatment with HAART, low viral load, and antepartum/intrapartum treatment with zidovudine?
These two findings, seen on the facial profile, necessitate delivery at a specialized institution with capability to perform EXIT procedure.
What are micrognathia and retrognathia?
The rate of sudden death due to thromboembolic disease in patients with mechanical mitral valve treated with lovenox.
What is 5%?