Академический Документы
Профессиональный Документы
Культура Документы
membranes
By : Ida Yosopa
Preceptor :
dr. H. Sigit Nurfianto, Sp. OG (K)
exordium
Definition
PROM is defined as spontaneous rupture of
the membranes (amniorrhexis) before labor at
any stage of gestation
If the rupture happened prior to 37 weeks, it
called preterm prematurely rupture of the
membranes (PPROM)
Premature Rupture of Membrane. Clinical Management Guidelines For Obstetrician Gynecologists: From Practice Bulletin.
Epidemiology
In the literature the incidence of premature rupture
Etiology
PROM
PPROM
Weakness power of
membranes in term
pregnancy, cause of:
-Enlarge uterus
-Uterus contraction
-Movement of fetal
The cause of
PROM is a wide
array of
pathological
mechanisms.
Physiology
...Physiology
Function
Shelter from dehydration, compression of the
umbilical cord, traumatic external influences
and gives room for the child to move and grow
and necessary for the development of the
lungs.
Patophysiology
...Patophysiology
...Patophysiology
...Patophysiology
While
delivery
approached,
degradation
Manifestation
Fluid passing through the vagina suddenly,
and then small amounts of fluid flow through
the vagina intermitently, particularly when the
increased of abdominal pressure (cough,
sneeze, et al)
Intermittent urinary leakage is common during
pregnancy, especially near term
Increased vaginal secretions in pregnancy
...Manifestation
Perineal moisture
Increased cervical discharge
Urinary incontinence
Speculum examination appears loss of
amniotic fluid from the endocervical canal
Nitrazin paper changed from red to blue
Lanugo and vernix casseosa by microscope
Evaluation
1. History
. The time of rupture and consistency of the
...Evaluation
1. Physical Examination
o.Vital sign
o.Sterile speculum examination (SSE)
. When visualizing the cervix, the dilation and
effacement should be noted.
. Nitrazin and fern tests are used to confirm rupture.
Nitrazin should show a pH between 7,1 7,3. False
positive test can be observed with blood, semen,
trichomonas, cervical mucus, and urine.
...Evaluation
...Evaluation
o Laboratory assessment
o Complete blood count and urinalysis
o Ultrasound (USG)
o Amnion fluid index, fetal presentation, estimated fetal
Fetal risk
Preterm brith
Neontal sepsis
Pulmonary hypoplasia
RDS
Contractures and deformities
Treatment guidelines in
preterm rupture of
membranes
Conservative
management
Antibiotic
ampicillin 4x500mg/erytromicin 4x500mg
metronidazole 2x500 mg to 7 days
GA 32-34 weeks hospitalize until amniotic fluid
stop to loss
...Conservative management
...Conservative management
Active management
GA >37 weeks do induction with oxitocin if
failed CS
Misoprostol 25g - 50g intravagina/6 hours
4X. If any infection give high dose of
antibiotic and termination pregnancy
If pelvic score <5, favorable cervix then
induction. If failed SC
If pelvic score >5 induction
complication
Prognosis
Prognosis depends on the age of the womb, the
mother and the state as well as the presence of
infection or not .
Premature Rupture of Membrane. The Medscape Journal of Medicine. 2011. Diunduh dari
http://www.emedicine.medscape.com
References
1. Mohr T. Premature Rupture of Membrane. Gynakol
Geburtsmed Gynakol Endokrinol 2009; 5(1):2836.
2. Prawirohardjo S. Ilmu Kebidanan. Ed 4th. Jakarta: PT. Bina
Pustaka Sarwono Prawirohardjo, 2009.
3. Mercer BM. Premature Rupture of The membrane in Maternal
fetal Medicine: Elsevier 2010