妇产科学教学课件：10 PREMATURE RUPTURE OF MEMBRANE (PROM)

PREMATURERUPTUREOFMEMBRANE(PROM)DefinitionPROMisruptureofmembranesbeforetheonsetoflaborMembranerupturebeforelaborandbefore37weeksofgestationisreferredtoaspretermPROM(PPROM)IncidencePROM:5%~15%ofalldelivery10%oftermpregnancyPPROM:2%-3.5%EtiologyVaginalinfectionorintraamnioticinfection:duetobacteria,virus,TOXO,CMV,HPVandHSV,etalTrauma(abdomenstrikedintensely):Sexualintercourse(inthelategestationalweeks)?SmokingPriorPROMorPPROMshortcervicallengthPriorpretermdeliveryBleedinginearlypregnancylowbodymassindexAffectonthemothersandinfantsMothersInfection:intraamniotic15–25%,postpartum15–20%Placentalabruption:2–5%ofPPROMPretermdeliveryInfantsPretermbabyandtheircomplications,(RDS/fetalandneurologicdysfunction,intracranialhemorrhage)Neonatalpneumonia,sepsisPulmonaryhypoplasia(发育不全)andRespiratorydistress:10–20%ProlapseorcompressionofcordPlacentalabruptionClinicalmanifestationFluidpassthroughthevaginasuddenly,andthensmallamountsoffluidflowthroughthevaginaintermittently,particularlywhentheabdominalpressureincreased(cough,sneezeetal)Infection:fever,heartrateofmotherand

infants↑,WBCandCRP↑,Uterine

tendernessonpalpation

DiagnosisSterilespeculumexaminationamnioticfluidpassingfromthecervicalcanalandpoolinginthevagina.Otherfindings:Cervicitis,umbilicalcordprolapseorfetalprolapse,cervicaldilatationandeffacement,obtainculturesPHdeterminationofvaginalfluid:≥6.5Theferntest(蕨形试验)Ultrasonography:amnioticfluidvolumeFetalfibronectin:sensitive,nonspecificAminoscopy(羊膜镜)

ManagementPROMattermAwaitingtheonsetofspontaneouslaborfor12-24h:50%,within5hours;95%,within28hours.Terminationofpregnancyafter24hours(withoutcontraindicationstolabor):Inductionoflaborwithoxytocin(atleast12–18hours)fetalheartratemonitoringGroupBstreptococcalprophylaxis:routineuse?ManagementPPROMTerminationofpregnancy

(1)Evidenceoffetalpulmonarymaturation

(2)EvidenceofintrauterineinfectionExpectanttherapy

(1)Evidenceoffetalpulmonaryimmaturation

(2)Withoutevidenceofintrauterineinfection:cultureforgroupBstreptococci(GBS)

ManagementToenhancefetalpulmonarymaturation24~34weeks,Asinglecourseofcorticosteroids(地塞米松),5mgQ12h*4<34weeks，intravenousMgSO4(fetalneuroprotectivetreatment)Antibiotic12hoursaftermembranerupture<34weeks(expectant),7-daycours