PROM

Diagnose Ruptured Membranes

• history of vaginal leakage of fluid
• speculum examination pooling of amnionic
fluid, clear fluid from the cervical canal, or both.
age.
– Amnionic fluid is alkaline (pH 7.1–7.3) vs vaginal
secretions (pH 4.5–6.0)
• Confirmation of ruptured membranes 
sonographic examination, assess :
– amnionic fluid volume
– identify the presenting part
– estimate gestational age.
MANAGEMENT OF PRETERM LABOR WITH
INTACT MEMBRANES
• If possible, delivery before 34 weeks is
delayed.
• Amniocentesis to Detect Infection
– evaluated diagnostic value of amnionic fluid :
• Elevated leukocyte count, a low glucose level, a high IL-
6 concentration, or positive Gram stain
resultconsidered infected
 Corticosteroids for Fetal Lung
Maturation
• effective in incidence of respiratory distress
syndrome & neonatal mortality rates if birth
was delayed for at least 24 hours after
initiation of betamethasone.
• repeated courses to be beneficial in 
neonatal respiratory morbidity rates
• dose : 12-mg betamethasone dose
• not generally used after 33 weeks
• “Rescue Therapy”
– single rescue course of antenatal corticosteroids
should be considered in women before 34 weeks
whose prior course was administered at least 7
days previously.
• Choice of Corticosteroid
– betamethasone is superior to dexamethasone
forfetal lung maturation
• Antimicrobials
– Cochrane meta analysis by King and colleagues
no difference in the rates of newborn
respiratory distress syndrome or sepsis between
placebo- and antimicrobial-treated groups.
• Bed Rest
– No evidence supporting or refuting the benefit of
either bed rest or hospitalization for women with
threatened preterm labor.
– Bed rest for 3 days or more increased
thromboembolic complications
• Cervical Pessaries
– being used to support the cervix in women with a
sonographically short cervix ( ≤ 25 mm)
• Emergency or Rescue Cerclage
– if cervical incompetence is recognized with
threatened preterm labor, albeit with risk of
infection and pregnancy loss.
 Tocolysis to Treat Preterm Labor
• tocolytic agents do not prolong gestation but
may delay delivery in up to 48 hours.
• recommended tocolytic agents for short-term
use (up to 48 hrs)
– Beta-adrenergic agonists,
– calcium-channel blockers,
– indomethacin
• β-Adrenergic Receptor Agonists (Ritodrine)
– Reduce intracellular ionized calcium levels &
prevent activation of myometrial contractile
proteins
– cause retention of sodium and cause volume
overload Pulmonary edema
• Magnesium Sulfate
– high concentration can alter myometrial
contractility.
– very-low-birthweight neonates whose mothers
were treated with magnesium sulfate for preterm
labor or preeclampsia incidence of cerebral
palsy
– Dose : IV 4 gram loading dose followed by a
continuous infusion of 2 g/hr
• Prostaglandin Inhibitors
– Inhibiting prostaglandin synthesis or by blocking
their action on target organsacetylsalicylate and
indomethacin
– Indomethacin : orally or rectally 50-100 mg tdd,
max dose of 200 mg
• Limited use to 24 to 48 hours oligohydramnios
 Calcium-Channel Blockers

• Myometrial activity is directly related to

cytoplasmic free calcium, and a reduction in its
concentration inhibits contractions
• nifedipine, are safer and more effective than are
β-agonists
• Combination of nifedipine with magnesium
potentially dangerous
• nifedipine neuromuscular blocking effects of
magnesium that can interfere with pulmonary
and cardiac function
 Labor
• abnormalities of fetal heart rate & uterine
contractions should be sought
• Fetal tachycardia, with ruptured sepsis.
• intrapartum acidemia (umbilical artery blood
pH <7.0) neonatal complications attributed
to preterm delivery severe respiratory
disease
• Prevention of Neonatal Intracranial
Hemorrhage

• Magnesium Sulfate for Fetal Neuroprotection