已阅读5页,还剩48页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
Modern Management of Prolonged Rupture of Membranes Joseph R. Biggio Jr., M.D. Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine University of Alabama at Birmingham PROM Amniorrhexis prior to onset of active labor regardless of gestational age Premature Rupture of Membranes PPROM Amniorrhexis 5,000 women randomized nOxytocin, PGE2 or expectant management up to 4 days nNo difference in cesarean section or neonatal infection nLess chorioamnionitis in induction with oxytocin group Hannah, NEJM, 1996 Epidemiology of Preterm Birth PPROM Spontaneous Preterm Delivery Indicated Preterm Delivery 28 % 46 % 26 % Andrews, 1995 PPROM Risk Factors lLower/Upper Genital Tract Infection i Proteases i Prostaglandins lHistory of PPROM lIncompetent Cervix lAbruption lPolyhydramnios lMultiple Gestation lSmoking PPROM Complications lMaternal/Fetal Infection lPremature Labor and Delivery lUmbilical Cord Prolapse lFetal Hypoxia 2 Cord Compression lIncreased Rate of Cesarean Section lIntrauterine Growth Restriction lAbruption lStillbirth PPROM Standard Management lConfirmation of Diagnosis lVerification of Gestational Age lR/O Labor/Infection/Fetal Compromise lAvoid Digital Vaginal Examinations lIn Hospital Observation lBedrest PPROM Latency Gestational Age (Weeks) % Patients with Latency 1 Week 25 50 75 0 Wilson, Obstetrics & Gynecology, 1982 PPROM Vaginal Examination Gestational Age (Weeks) 20 15 10 5Latency Days No Exam Exam Lewis, Obstetrics & Gynecology, 1992 Previable PPROM l28 d Kenyon, Cochrane Library, 1999 Antibiotics & PPROM: Summary lNo clear reduction in perinatal death lNo clear reduction in cerebral abnormalities Kenyon, Cochrane Library, 1999 Amniocentesis PPROM Amniotic Fluid Culture l Group B Streptococcus 20 % l Gardnerella vaginalis 17 % l Peptostreptococcus 11 % l Fusobacteria 10 % l Bacteroides fragilis 9 % l Other Streptococci 9 % l Bacteroides sp. 5 % Utility of Amniocentesis lConfirm/Refute diagnosis of chorioamnionitis i Glucose 15 mg/dL i Culture i Gram stain lLung maturity testing Corticosteroids Corticosteroids for FLM lBetamethasone lDexamethasone PPROM Corticosteroids Block Taeusch Papageorgiou Young Garite Collaborative Iams Nelson Simpson Morales 43 17 17 38 80 153 38 22 112 121 26 24 19 37 80 135 35 46 105 124 Author Steroids Control Effect on RDS Number of Patients PPROM Corticosteroids Crowley, Ob/Gyn Clinics, 1992 * PPROM Corticosteroids + Antibiotics * Lewis, Obstetrics & Gynecology, 1996 1994 NIH Consensus Conference: Corticosteroids in PPROM lCorticosteroids reduce incidence/severity of RDS, IVH lBenefits in PPROM up to 30-32 weeks lNo significant adverse outcomes for corticosteroid use in PPROM lImpact less than with intact membranes Observation vs. Induction Neonatal Morbidity/Mortality UAB (1995-1996) % PPROM Observation vs. Induction Mercer, AJOG, 1993 * * PPROM Observation vs Induction Cox, Obstetrics & Gynecology, 1995 Fetal Lung Maturity Testing Fetal Lung Maturation Biologic Markers 8 6 4 2 0 0 4 2 6 8 20 24 28 32 36 40 Gestational Age (weeks) L:S Ratio % Phospholipid L:S PI PG 10 Fetal Lung Maturity Evaluation in Vaginal Pool Specimen lL:S Ratio Not Reliable lTDX:FLM Assay Not Validated lPG Useful Fetal Surveillance PPROM Fetal Surveillance lDaily Non-Stress Test (NST) i Variables i Tachycardia i Loss of reactivity lBiophysical Profile (BPP) lContraction Stress Test (CST) Summary UAB Management of PPROM PPROM 34 weeks Deliver Previable PROM Outpatient observation Antibiotic prophylaxis Option of termination 22wk Admission at viability PPROM 23 weeks, 34 weeks Antibiotic pro
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 2024届广西南丹中学中考适应性考试英语试题含答案
- 2024届广西北海市达标名校中考三模英语试题含答案
- 2024届广东省潮州市潮安区雅博校中考英语模拟预测题含答案
- 2024年网状蓬松石英棉项目建议书
- 2024届鞍山市重点中学中考考前最后一卷英语试卷含答案
- 小学生150-200字的作文(共28篇)
- 小鬼当家作文(合集11篇)
- 我有一个超能力的作文300字(合集29篇)
- 工笔构图教学反思总结(3篇)
- 电视广告制作合同范本10篇
- 我最爱的书米小圈上学记图文.ppt
- 材料力学课程设计五种传动轴的静强度、变形及疲劳强度的计算
- 1美发与形象设计专业建设方案
- 饮酒后人体血液中酒精含量的变化规律
- 冲压安全操作规程
- 燃气燃烧器回火现象及其预防措施
- 中国石油天然气集团职称评考核细则说明.
- 中交股份财务共享服务中心体系的设计
- 土方平整施工方案(完整版)
- 运输协议书(简单版)
- 药品不良反应报告的评价与药物警戒中的信号问题.ppt
评论
0/150
提交评论