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Re: Premature AmniorrexisFrom: dahmd@gate.netFri Mar 22 16:32:06 1996
Gettenberg Primo wrote:
>One patient 15 years old, good condition, leucograma normal, have a lose of amniac I'm assuming that there will be many different opinions on this question. There are a number of questions that need to be addressed: 1. Do you use steroids for pulmonary maturation in a patient with preterm, premature rupture of membranes (PPROM)? Some advocate this, others do not. 2. Will you perform an amniocentesis to rule out an intraamniotic infection? 3. If an infection is present, would you attempt treatment, or go on to induction of labor? 4. If the patient is given "expectant management" with bedrest and monitoring of fetal heart rate, maternal temperature, and uterine tenderness, would you keep the patient in the hospital, or send her home after a few days if there is no labor or signs of infection or abruption? 5. Did anybody perform a digital exam on the patient (hopefully not)? 6. If the baby is breech, would you attempt breech delivery, or cesarean section? Many advocate c/section if the baby is breech and between 750 grams and 2000 grams. Each case of PPROM is unique. In general, I tend to perform an amniocentesis, treat with steroids (if absent infection), observe closely for *at least* 48 hours in the hospital, and *consider* sending the patient home for home monitoring if there are not signs of labor, infection, or abruption, if the patient is reliable, has help at home, owns a thermometer, has a phone, and lives close by, and if the baby is vertex. I always keep patients with breech or transverse lie in the hospital to monitor for cord prolapse. Although there are data to support home management of PPROM, I admit that I am *much* more comfortable keeping these patients in the hospital. I would keep this patient, who is only 15 years old, in the hospital until she delivered! If there is a strong suspicion of chorioamnionitis, I would deliver. I would NEVER perform a digital exam on this patient unless I saw the head (or other body part) coming through the labia! I have struggled to teach ER doctors and others that the latent phase from rupture until delivery is shortened dramatically by performing a digital exam. They invariably tell me "I checked her because I'm not going to get sued when the baby drops out in the ambulance on the way over to you". Please let us know what you did with this patient. Thanks, Ashley Hill D. Ashley Hill, M.D. dahmd@gate.net
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