Case: PPROM

Question:

a) Symptoms of fever

b) Possitive findings in PPROM

c) Ix and Mx

d) Causes of unstable lie

PPROM

Membrane rupture that occurs before 37 weeks of gestation is referred to as preterm PROM

Intraamniotic infection has been shown to be commonly associated with preterm PROM, especially if preterm PROM occurs at earlier gestational ages. In addition, factors such as low socioeconomic status, second- and third-trimester bleeding, low body mass index less than 19.8, nutritional deficiencies of copper and ascorbic acid, connective tissue disorders (eg, Ehlers–Danlos syndrome), maternal cigarette smoking, cervical conization or cerclage, pulmonary disease in pregnancy, uterine overdistention, and amniocentesis have been linked to the occurrence of preterm PROM

The risk of recurrence for preterm PROM is between 16% and 32%.

Fever

Fever is considered as temp above 100.4⁰ (38⁰C) but feverish sensation may occur when body temp above 98.6⁰ (37⁰C)

Symptoms

1) Patient complaints of body become hot and sweating (increase temperature and diaphoresis)

2) Can also a/w with tachycardia, altered consciousness, chills & rigor, headache, muscle and joint pain.

Positive findings in PPROM

1) Clear watery and alkaline per vaginal discharge. (pH 7.1-7.3 compared with vaginal pH 4.5-6.0)

2) Arborization (ferning) under microscopic visualization

3) Oligohydramnios

[ACOG Practice Bulletin, VOL. 109, NO. 4, APRIL 2007]

Symptoms of chorioamnionitis: High grade fever, maternal and fetal tachycardia, tender uterus.

Investigation and management

**Based on period of gestation but basically

1. Determination of gestational age, fetal presentation, and well-being

2. Expeditious delivery in patient patient with evident intrauterine infection, abruptio placentae, or evidence of fetal compromise

3. swabs for diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae if immediate delivery not indicated

4. Group B antibiotic prophylaxis

5. CTG monitoring for umbilical cord compression or asymptomatic uterine contraction.

Causes of unstable lie

1. Prevention of head descending

a) Cephalopelvic disproportion

b) Fibroid

c) Ovarian cyst

d) Placenta previa

e) Uterine surgery

f) Multiple gestation

g) Fetal abnormality (anencephaly)

h) Fetal neuromuscular disorder

2. Condition that permit free fetal movement

a) Polyhydramnios (AFI>8)

b) Uterine laxation