Hung Vuong Hospital Medical English Class (ME01)
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- The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available.
- Membrane rupture may occur for a variety of reasons. Although membrane rupture at term can result from a normal physiologic weakening of the membranes combined with shearing forces created by uterine contractions, preterm PROM can result from a wide array of pathologic mechanisms that act individually or in concert.
- The rate of pulmonary hypoplasia after PROM before 24 weeks of gestation varies widely among reports, but is likely in the range of 10–20%. Pulmonary hypoplasia is associated with a high risk of mortality, but is rarely lethal with membrane rupture subsequent to 23–24 weeks of gestation (29), presumably because alveolar growth adequate to support postnatal development already has occurred. Early gestational age at membrane rupture, and low residual amniotic fluid volume are the primary determinants of the incidence of pulmonary hypoplasia.
ACOG: Prelabor Rupture of Membranes (download: click here)
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