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Re: Doubts about AFI in PROMFrom: dahmd (dahmd@gate.net)Tue Jun 3 17:52:16 1997
Ricardo Savaris wrote:
> I have seen a few PROM on the last couple of days and I have a doubt about Ricardo- Management would depend on the gestational age. If the patient is at 34 weeks or greater (some would say 32 weeks or greater), I strongly consider induction of labor with possible prophylactic amnioinfusion. If less than 37 weeks, or if prolonged ROM (say greater than 18 hours) I usually prescribe antibiotics. If she is really preterm I usually prescribe antenatal steroids (controversial) and antibiotics, and do not offer tocolysis if labor ensues. I would hospitalize the patient with continuous fetal monitoring since she is at risk for variable decelerations with possible hypoxemia. Furthermore, I always worry about chorioamnionitis in these cases, and would observe her closely with abdominal exams, temperatures, and fetal monitoring. In preterm situations if I can perform an amniocentesis (pretty tough with an AFI of zero!) then I will do so to help rule out infection, and to check for pulmonary maturity if over 32 weeks or so gestational age. Finally, if extremely preterm (essentially nonviable) then I counsel on the risks of continuing the pregnancy versus expectant management, and if the patient desires, will induce labor for the indication of extreme prematurity with PPROM. If she wants expectant management, I will usually offer to discharge her home with regular vital signs, and subsequent hospitalization when a reasonable viability is reached. This pretty much covers the scheme where I practice, although, of course, there are variations depending on the clinical situation. I hope this helps, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando,FL
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