PROM vs. PPROM

 PROM (Premature Rupture of Membranes): ≥37 weeks-এ amniotic sac rupture গেল, কিন্তু spontaneous labor শুরু হলো না। এরকম হলে এটাকে PROM বলি বা term prom ও বলা হয়ে এটাকে।

 PPROM (Preterm Premature Rupture of Membranes): <37 weeks-এ membranes rupture হয়ে যায়, contractions ছাড়াই।

 Etiology & Risk Factors

 Infections – Chorioamnionitis, UTI, bacterial vaginosis 

 Cervical insufficiency – Weak cervix → pressure সহ্য করতে পারে না

 Multiple pregnancy – Uterus overstretched → rupture risk ↑

 Previous PROM বা Preterm birth – Recurrence risk বেড়ে যায়

 Smoking & Poor Nutrition – Collagen breakdown → membrane weak 

 Polyhydramnios বা abrupt stretching – Excessive tension → rupture

 Pathophysiology (কেন হয়?)

 Inflammation বা infection → Collagen degradation & apoptosis → Membrane thinning & rupture

 Bacterial endotoxins → Prostaglandin release → Weakening of amniotic membrane

 Oxidative stress & MMP (matrix metalloproteinase) activation → Chorioamniotic barrier breakdown

 Uterine overdistension (Polyhydramnios, Twins) → Increased pressure → Premature rupture

 Clinical Features (Key Symptoms)

 Sudden gush বা slow leakage of fluid from vagina

 Clear, yellowish, বা slightly blood-tinged amniotic fluid

 Lower abdominal discomfort বা cramping

 Uterine tenderness & fever → Chorioamnionitis এর লক্ষণ

 Diagnosis & Investigations (Findings Explained)

 Speculum Examination:

 Pooling of fluid in posterior fornix – Amniotic fluid continuous leakage করলে posterior fornix-এ জমা হয়।

 Nitrazine Test (pH Test):

 Amniotic fluid pH >7.1 (alkaline), যেখানে vaginal secretion সাধারণত acidic (pH 4.5-6)।

 কারণ amniotic fluid-এর bicarbonate concentration vaginal secretions-এর তুলনায় বেশি, তাই vaginal pH alkalotic হয়।

 False positive হতে পারে semen, blood, or bacterial vaginosis এর কারণে।

 Fern Test (Microscopy):

 Amniotic fluid air-dry করলে microscopic ferning pattern দেখা যায়।

 কারণ sodium & protein crystallization একটি distinctive fern-like pattern তৈরি করে।

 False negative হতে পারে যদি fluid contamination থাকে বা inadequate sample collect হয়।

 Ultrasound (AFI Measurement):

 Oligohydramnios (low AFI) পাওয়ার সম্ভাবনা বেশি, কারণ amniotic fluid leakage হয়ে যাচ্ছে।

 তবে PROM থাকলেও AFI normal থাকতে পারে, যদি fluid leakage intermittent হয়।

 AmniSure/Actim PROM (Biochemical Test):

 Placental α-microglobulin-1 (PAMG-1) এবং insulin-like growth factor binding protein-1 (IGFBP-1) presence detect করে।

 Highly specific & sensitive diagnostic test যা infection বা contamination-এর কারণে false positive দেয় না।

 Complications (Untreated হলে কী হতে পারে?)

 Preterm labor & delivery – Fetal lung immaturity

 Fetal distress & cord prolapse – Reduced oxygen supply

 Chorioamnionitis & maternal sepsis – Bacterial invasion

 Neonatal respiratory distress syndrome (RDS) – Surfactant deficiency

 Management & Treatment (Clinical Approach)

 < 34 weeks:

 Hospital admission & monitoring

 IV antibiotics (Ampicillin + Erythromycin) → infection risk ↓

 Corticosteroids (Betamethasone/Dexamethasone) → fetal lung maturity ↑

 Tocolysis (if needed) → contractions delay করার জন্য

 ≥37 weeks:

 Spontaneous labor না হলে induction with oxytocin

 Avoid digital examination – Infection risk বাড়ে

 Monitor for chorioamnionitis – Fever, uterine tenderness, foul-smelling discharge

 <37 weeks (PPROM):

 Hospital admission & monitoring

 IV antibiotics (Ampicillin + Erythromycin) – Infection & latency prolongation

 Corticosteroids (Betamethasone/Dexamethasone) – Fetal lung maturity ↑

 Tocolysis (if no infection & <32 weeks) – Delay contractions

 Magnesium sulfate (<32 weeks) – Neuroprotection for preterm babies

 Immediate delivery if:

 Chorioamnionitis develops (Maternal fever, tachycardia, uterine tenderness)

 Non-reassuring fetal status (Late decelerations, tachycardia)

 Cord prolapse or abruptio placentae

Raiyyan Tahsan. Date:-4-03-2025 Tuesday Time:-11-12-20 Pm

• TC(1487).(56). General Medicine Department Case No (14): Presumed Treated Hypertension and Type 2 Diabetes with Possible Upper-GI Dyspepsia/Dysmotility and Cardiovascular Risk Management (1 Prescription + 0 Reports + 0 Supporting Images).5432
• TC(1486).(02). Dermatology Department Case No 107:- Suspected Superficial Dermatophytosis with Possible Coexisting Allergic Rhinitis: Clinical Diagnosis, Prescription Analysis and Evidence-Based Management (1PR+0RE+0IMG)4433
• TC(1485).(02). Dermatology Department Case No (106): Undifferentiated Genital Ulcer Disease with Associated Skin Rash and Generalized Weakness Suspected Syphilis versus Genital Herpes; Possible Secondary Bacterial Infection (1 PR+ 0RE + 0Img)7799
• TC(1484).(09).Obstetrics & Gynecology Case No 60:-High-Risk Pregnancy with History of Two Preterm Deliveries and Two Neonatal Deaths: Diagnosis, Drug Safety and Evidence-Based Management(1PR+0RE+0IMG)8090
• TC(1483).(09). Gynecology Department Case No. (59): Physician-Documented Mastitis with Fever — Possible Inflammatory or Bacterial Mastitis; Breast Abscess and Dengue Fever to Be Excluded (1Prescription + 0Reports + 0Images)0909

Search

Search