Pprom

[Ahmed Al-Kaisy]

pregnant lady 34 wks come to u with rupture membrane 2 hrs ago. no uterine contractions on examination. foot appears from the cervix, with 4 cm dilation. what is the next step:

1.C/S
2.Close monitoring of fetal heart
3.U/S
4.Induction of labour

[bloodstone]

Induction of labour..
it resembles the final year question..mo?

[asclepius]

i'm not very sure about the answer but i don't think induction of labour or having a c-section should be done because the fetus is still 34 weeks old. an ultrasound would be done anyway in such cases to verify the presenting part.

i suppose corticosteroids should be given to promote lung maturity with antibiotics to prevent an ascending infection and continuous monitoring is provided so they can proceed to c-section if there is any fetal distress later.

so i would choose 2 although i'm not completely sure.

[husam matheel]

2nd choice

[Hour_Glass]

2.close monitoring of fetal heart .



asclepius, this case doesn't need a corticosteroid the fetus is older than 32 wks.but sure he needs antibiotic cover .

also i don't think the guy is gonna come the easy way (i.e.NVD) cause the case is describing footling or at least compound breech.

[Ahmed Al-Kaisy]

Hey guys, this is the approach to PPROM:

* If uterine contractions occur, tocolysis is contraindicated.
* If chorioamnionitis is present, obtain cervical cultures, start broad-spectrm therapeutic IV antibiotics, and initiate prompt delivery.
*If no infection is present, management will be based on gestational age as follows:
- Before viability (<24 weeks) : Induce labor or bed rest.
- With preterm viability (24-33 weeks): bed rest, Im betamethasone if less than 32 weeks, cervical cultures, prophylactic AB.
- At term (>= 34 weeks): initiate delivery. if VD is expected, induce otherwise CS.


Since the gestational age is 34 so the option is delivery, 3 options available:
* External version: we need a non ruptured membrane.
* Vaginal delivery: footling presentation is a relative contraindication to VD and should only be attempted if the patient insist on it.
* Cesarean delivery: is the best option in this case.

P.S.: relative contraindications to VD in breech presentations include nulliparity, incomplete breech presentation and estimated fetal weight greater than 3,800 g.

[asclepius]

thanks for the explanation.

i actually thought even with 34 weeks gestational we should wait.