Gush Of Fluid



Sterile Spec.

- Pooling, Nitrazine and Ferning

Negative(-)

  • Expectant Management/Follow-up






Summary Table

Gush of Fluid
Sterile speculum to r/o PROM (Pooling, Nitrazine, Ferning)
(-) (+)
Expe. Mgt, PROM P-PROM
Spontaneous ROM before onset of labor regardless of gest. age.

Cause: Infection (chorio.)

Labs: Cath UA w/ micro & C/S, UDS, CBC, BMP, fetal fibronectin.

Exam: Vaginal exam to assess cervical change, EFM.

Tx: EFM, Immediately deliver for fetal distress of maternal infection.

 

PROM that occurs < 37 wks.

Causes/Risk: Intrauterine infection, placenta abruption, previous PROM, & smoking.

Labs: Cath UA w/ micro & C/S, UDS, CBC, BMP, GBS, GC, Chlamydia,  fetal fibronectin, AmniSure (Placental Alpha microglobulin-1 protein = amniotic fluid protein),

Tests: OB Ultrasound (oligo. is suggestive of ROM), Amniocentesis & installation of Indigo Carmine (for ambiguous cases), Lecithin/sphingomyelin ratio (assess Fetal lung maturity).

Exam: EFM, NO digital cervical exam.

Tx:

  • Admit to L&D on EFM.
  • Observe for S/S of chorio (fever) and abruption (painful bleed)
  • DELIVER if (+) infection or non-reassuring FHT.
  • Prolonging preg. after ROM = intrauterine infection + neonatal sepsis.
  • GBS proph, Steroids.
> 34 wk 32-34 wk 24-32 wk < 24wk
Deliver Lungs mature:
- DELIVER

Lungs not mature:
- Steroids
- ABx
 
- Betamethason 12mg IM q12h x 2
- ABx (7days):
Ampicillin 2g + erythromycin 250 mg IV q6h x 48h. Followed by amoxicillin 250mg + EC erythromycin 333mg q8h x 5 d.
- GBS proph. x 48hrs (no additional ABx required it pt already on Ampicillin)
-Tocolytics: NOT effective in setting of ROM
- Expe. mgt.
- No need for GBS proph, ABx or Steroids.
- PPROM (no contractions) <23 wk can be d/c home for expt. mgt. and readmit at 24 wks for steroids & ABx

PPROM