How is premature rupture of membranes diagnosed?

summary

Premature rupture of membranes (PROM) refers to spontaneous rupture of membranes before labor. In our daily life, we need to eat more fresh fruits and vegetables. According to the gestational age, we can divide them into term PROM and preterm PROM (PPROM). The incidence of prom in term singleton was 8%, PPROM in singleton pregnancy was 2-4%, and PPROM in twin pregnancy was 7-20%. So we come to understand how premature rupture of membranes diagnosed??

How is premature rupture of membranes diagnosed?

First: clinical symptoms and signs: pregnant women complain of sudden vaginal fluid flow or uncontrolled "leakage of urine". A few pregnant women feel that the vulva is wetter than usual. The diagnosis can be made when the amniotic fluid mixed with fetal fat flows out of the cervix by the scrotum examination. It is worth noting that the application of sterile speculum for inspection, and avoid finger check to prevent upward infection.

Second: vaginal pH measurement: the pH value of normal vaginal fluid was 4,5-6.0, and the pH value of amniotic fluid was 7.0-7.5. After rupture of fetal membrane, the pH value of vaginal fluid increased (pH ≥ 6.5). The pH value is usually determined by NITROQUINE or litmus test paper. If there is a pool in the posterior fornix and the test paper turns blue, the diagnosis can be made. However, cervicitis, vaginitis, blood, soap, urine, semen or preservatives may cause false-positive pH test. The sensitivity of pH value in the diagnosis of PROM was 90%, and the false positive rate was 17% (grade II / b).

Third: vagina fluid picture: take vagina fluid to smear on the glass slide, after drying, observe under the microscope, appear fern crystal, prompt for amniotic fluid. Semen and cervical mucus can cause false positive. The sensitivity of PROM is 51-98%. The false positive rate was 6%. Generally, it is used when the prom cannot be determined by the above check (Level II / b).

matters needing attention

Antibiotics used to prevent GBS infection: (1) the first dose of penicillin G was 4.8 million units intravenous drip, then 2.4 million units / 4H until delivery; Or ampicillin, loading dose 2G intravenous drip, then every 4 hours 1g intravenous drip until delivery（ 2) For those allergic to penicillin, cefazolin was given intravenously at a starting dose of 2G, then 1g every 8 hours until delivery（ 3) For those allergic to cephalosporins, erythromycin 500mg was given intravenously every 6 hours; Or clindamycin 900 mg intravenous drip, once every 8 hours.