PRETERM RUPTURE OF THE MEMBRANE

FETAL MEMBRANE

A thin tissue that surrounds the fetus during gestation and is critical for maintaining a pregnancy to delivery.

Because the fetal membranes have no nerve supply, rupture does not produce pain for the fetus or the mother.

Why do the fetus and mother not experience pain when the fetal membranes spontaneously rupture at term or are artificially ruptured?

AMNIOTIC MEMBRANE

this also produces the amniotic fluid.

AMNIOTIC FLUID

What does the amniotic membrane produce that surrounds and supports the fetus during pregnancy?

37 WEEKS

Before how many weeks of pregnancy is the rupture of fetal membranes with loss of amniotic fluid considered preterm?

COLLAGEN

is an essential component of connective tissue and plays a crucial role in holding the body's cells together.

REMODELING

compact layer of the amnion the major component of the basement membrane of amnion

APOPTOSIS

cell shrinks and pulls process of programmed cell death

MECONIUM

What does green or brown amniotic fluid indicate?

CLEAR OR SLIGHTLY YELLOW (STRAW-COLORED)

What is the normal color of amniotic fluid?

INFECTED AMNIOTIC FLUID

What does a foul odor in amniotic fluid indicate?

800–1,200 mL

What is the normal amount of amniotic fluid at term?

If it persists for more than 24 hours before the onset of labor

When is rupture of membranes considered prolonged?

ACIDIC

Urine pH 5.0-5.5

HIGHER THAN 7.2

What pH value of amniotic fluid indicates that the membranes have ruptured?

NITRAZINE TEST

involves putting a drop of fluid obtained from the vagina onto paper strips containing nitrazine dye. Strips change color depending on the PH.

BLUE STRIPS

means more likely membranes have ruptured

APPEARS BLUE

Amniotic fluid causes ALKALINE reaction on the paper

REMAINS YELLOW

Urine causes an ACIDIC reaction

FERNING TEST

if water is broken the fluid mixed together with estrogen creating a “fern like” pattern due to salt crystallization 

FERNING TEST

A few drops of fluid is placed on a microscope slide on a microscope slide and observed under a microscope.

ALPHA FETOPROTEIN

is a substance produced by the fetal liver found in amniotic fluid and maternal serum

ALPHA FETOPROTEIN

Test done to check risk of birth defects and genetic disorders, neural defects or down syndrome. Increase level of this test if fetus has open spinal or abdominal defect because the open defect allows this test to enter the mothers circulation

ALPHA FETOPROTEIN

this test in vaginal fluid is a highly accurate diagnosis of PROM which is found in a leaked amniotic fluid

AMNIOTIC FLUID INDEX

quantitative estimation of amniotic fluid and an indicator of fetal well being.

AMNIOTIC FLUID INDEX

the score given to the amount of fluid seen on ultrasonography. 

5 cm – 25 cm

What is the normal amniotic fluid index (AFI) range for a healthy fetus?

OLIGOHYDRAMNIOS

What does an AFI less than 5 cm indicate?

POLYHYDRAMNIOS

What does an AFI greater than 25 cm indicate?

CHORIOAMNIONITIS

What is the complication of pregnancy caused by bacterial infection or inflammation of the fetal amnion and chorion membranes?

AIM TO INCREASE GESTATION

Before 34 weeks of gestation, what is the preferred management regarding delivery?

INDUCTION OF LABOR WITHIN 24-48 HRS

After 36 weeks of gestation, if labor has not started, what should be considered?

Because the risk of infection outweighs any benefit of the fetus remaining in utero

Why is labor induction considered after 36 weeks if it hasn’t started?

Within 24–48 hours

How soon do women typically go into labor after rupture of membranes?

OXYTOCIN

the medication of choice for augmenting contractions.

OXYTOCIN

stimulates the uterine muscles to contract and also increases production of prostaglandins, which increase the contractions further.

ARRHYTHMIAS

What cardiac complication can occur due to oxytocin stimulating the release of atrial natriuretic peptide (ANP) in the heart?

TOCOLYTIC AGENT

What is a drug designed to inhibit contractions of myometrial smooth muscle cells called?

AMNIOINFUSION

is a technique healthcare providers use to add amniotic fluid to the uterus. It's most commonly performed during labor when a fetus shows signs of a slow or irregular heart rate due to low amniotic fluid.

LOW AMNIOTIC FLUID

this can compress the umbilical cord and cause other delivery complications.