A rupture of membranes before the onset of labor is called prematurely. The diagnosis is made clinically. A delivery is recommended if a gestational age ? 34 weeks is present and is indicated generally at signs of infection or fetal impairment, regardless of gestational age.
Premature rupture of membranes (premature rupture of membranes, PROM) can (called PROM prior appointment at <37 weeks) at term (? 37 weeks) or earlier occur.
A rupture of membranes before the onset of labor is called prematurely. The diagnosis is made clinically. A delivery is recommended if a gestational age ? 34 weeks is present and is indicated generally at signs of infection or fetal impairment, regardless of gestational age. Premature rupture of membranes (premature rupture of membranes, PROM) can (called PROM prior appointment at <37 weeks) at term (? 37 weeks) or earlier occur. An early premature rupture triggers preterm birth in some cases. PROM any time increases the risk of infection in women (chorioamnionitis) and / or the newborn (sepsis) and the risk of abnormal fetal position and placental abruption. Group B Streptococcus and Escherichia coli are common causes of infection. But other pathogens in the vagina can cause an infection. PROM may increase the risk of intraventricular hemorrhage in newborns; intraventricular hemorrhage may have a disability neural development (z. B. cerebral palsy) result. A PROM well ahead of schedule prior to viability (<24 weeks) increases the risk of limb deformities (eg. As abnormal joint documents) and pulmonary hypoplasia due to leakage of amniotic fluid (called Potter sequence or syndrome). The interval between PROM and the beginning of the spontaneous contractions (latency period) varies inversely with the gestational age. On date> 90% of pregnant women with PROM begin their labor within 24 hours; after 32-34. SSW is the average latency period four days. Symptoms and complaints as long as there will be no complications, usually the only symptom of PROM seepage or a sudden gush of fluid from the vagina. Fever, viscous or foul-smelling vaginal discharge, abdominal pain and fetal tachycardia, especially if it is out of proportion to maternal temperature can heavily involved an chorioamnionitis. Diagnosis caseosa Vaginal collecting amniotic fluid or visible vernix or meconium vaginal fluid with Farnkrautphänom or alkalinity (blue color) on Nitrazinpapier Sometimes ultrasound-guided amniocentesis with dye to confirm order PROM to verify to assess cervical dilatation, collect amniotic fluid for fetal lung maturity tests and to bacteriological to win concessions from the cervix, a sterile speculum must be performed. A digital vaginal examination, and especially multiple studies to increase the risk of infection and should be best avoided, unless an imminent birth is accepted. The fetal position should be assessed. Is suspected subclinical intraamnial infection amniocentesis (extraction of amniotic fluid under sterile conditions) can confirm this infection. Tips and risks is premature rupture of membranes suspects should be avoided, a digital vaginal examination, unless the birth seems imminent. From diagnosis is assumed if the amniotic fluid from the cervix seems to run or if vernix caseosa or meconium can be seen. Vaginal secretions, which on a slide shows the Farnkrautphänomen in drying or litmus paper turns blue (indicating an alkaline environment and therefore amniotic fluid – normal vaginal fluid is acidic), one of the less secure sign. The litmus test may be false positive if the sample contaminated by blood, semen, alkaline antiseptics or urine or woman suffering from bacterial vaginosis. A recognized on ultrasound oligohydramnios suggests the diagnosis. In an unclear diagnosis indigo carmine dye may be administered by means of ultrasound-guided amniocentesis. The appearance of the blue dye on a vaginal tampon or “PERIPAD” confirms the diagnosis. If the fetus is viable, the women are referred generally to a clinic for regular fetal examination. Treatment delivery in fetal impairment, infection, gestational age> 34 weeks Otherwise rest position of the pelvis, close monitoring, antibiotics and occasionally corticosteroids for the treatment of PROM has the risk of infection if the birth is delayed, be weighed against the risks arising from fetal immature at birth directly taking place result. There is not the right strategy, but generally (eg. As persistently abnormal fetal test results, pressure pain sensitivity of the uterus plus. Fever) should be immediate delivery for signs of fetal impairment or infection. Otherwise, the delivery for a variable period can be delayed when the fetal lungs are still immature or the birth could begin spontaneously (d. H. Later in pregnancy). An induction of labor is recommended> 34 weeks of gestational age. If adequate treatment is not secured, an amniocentesis to assess fetal lung maturity can be made, which can lead to treatment; the sample can be obtained from the vagina or by amniocentesis. Expectant care For expectant behavior, the woman should limit their activity towards a modified bed rest and keep the pool in complete tranquility. Blood pressure, heart rate and temperature must be measured ? 3 times / day. Antibiotics (usually over 48 hours ampicillin and erythromycin iv, followed by amoxicillin and erythromycin orally for 5 days) are given; they extend the latency period and reduce the risk of neonatal morbidity. At <34 weeks corticosteroids to accelerate fetal lung maturity should be given (Preterm labor: corticosteroids). Magnesium sulfate i .v. should be considered in pregnancies <32 weeks of gestation into account; in utero exposure to this drug seems the risk of serious neurological disorders (eg. as a result of intraventricular hemorrhage), including cerebral palsy, to reduce in newborns. The administration of Tocolytics (drugs that stop the contractions) for the treatment of a PROM before appointment is controversial; their application must be resolved case by case. Summary It can be assumed that a rupture when amniotic fluid accumulates in the vagina or if vernix caseosa or meconium can be seen. Less-specific indicators of a PROM are Farnkrautphänoment in vaginal secretion, alkaline vaginal fluid (detected by paint must paper) and oligohydramnios. An induction of labor should be considered if fetal impairment, infection or evidence of fetal lung maturity or gestational be> 34 weeks of gestation. If no delivery is displayed, the treatment consists of bed rest and antibiotics administration. If pregnancies <34 SSW, give corticosteroids to accelerate fetal lung maturity, and when pregnancies <32 weeks of gestation, pull magnesium sulfate into consideration in order to reduce the risk of severe neurological dysfunction.