Obstetric Emergencies with Dr. Flood-Shaffer

Rupture of membranes (ROM) can happen spontaneously during normal labor or at times are artificially rupture by the healthcare team, however problems arise when these rupture prematurely

Premature Rupture of Membranes (PROM) occurs when membranes rupture prior to the onset of labor when a pregnancy is at term (greater than or equal to 37 weeks) and requires admission

Preterm Premature Rupture of Membranes (PPROM) occurs when PROM occurs when the pregnancy has not yet reached term

The typical precipitant for PROM or PPROM is a bacterial infection

A diagnosis of PROM (or PPROM) should be considered anytime a pregnant woman is complaining of leakage of fluid from her vagina and prompt a sterile speculum exam

If PROM/PPROM is on the DDx avoid a digital exam until you've ruled it out

Pregnant women presenting to the ED with vaginal bleeding who are over 20 weeks gestation should similarly not have a digital exam until placenta previa can be ruled out

Tests for PROM/PPROM include ferning (placing fluid on a slide to let dry and assess for a broad-leafed fern pattern under microscopy), however, this is only 51% sensitive and 75% specific

There are newer testing kits available to test for placental alpha-microglobulin (PAMG-1), which is 99% sensitive

Management of PROM is delivery, which is typically induced by OB

Management of PPROM in later pre-term period (34-37 weeks) is typically delivery by OB

Management of PPROM from viability (at ~24 weeks) to 34 weeks is typically expectant management with antibiotic therapy for presumed ascending infections (and also GBS prophylaxis), steroids for fetal lung maturity, and in attempt to prolong the pregnancy safely through reduced activity

Strict bedrest is a thing of the past, while minimal activity is still encouraged the risks of strict full time bedrest can be equally detrimental

Management of PPROM before 24 weeks is typically significant counseling as the pregnancy is likely non-viable

Many women experience contractions throughout their pregnancy and these should be classified as whether they are associated with cervical change

The common term of "Braxton-Hicks Contractions" are now referred as false contractions and are quite common and may start out as regular, they typically quickly become irregular and extinguish in a change in activity

Preterm contraction not associated with cervical changes can be treated with sedation (i.e. hydroxyzine) and hydration

Preterm labor is defined as regular contractions that are associated with cervical changes prior to 37 weeks gestation and accounts for 12.3% of births in the US