Medicine an Surgery notes

Apr 24th, 2015
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PREMATURE RUPTURE OFTHE FETAL MEMBRANESMageto A.J1Objectives Anatomy& function of fetal membranes Definitions/ terminology Magnitude of problem Mechanisms of SROM Factors associated with PROM Goal of management Approach to a patient with PROM2IntroductionSurround amniotic cavityComposed of amnion & chorionVarious cells embedded in a collagen matrixAvascular, & no nervesFunctionsRetain amniotic fluidSecret substances into amniotic fluid & towards theuterusGuard fetus against infection ascending reproductivetract3Definitions PROM:rupture of membranes beforeonset of labor PPROM: rupture of membranes before37 weeks Prolonged PROM: >24hrs before onsetof labor4IncidencePROM: 8-10 % after 37 weeks PPROM: 1% of all pregancies In MTRH, very common problrm inobstetrics at any one time 1-2 patientsin the ward with PPROM5Magnitude of the problem PPROMass. With 30-40% of pretermdeliveries~ [ complications: RDS,neonatal sepsis, intraventricularhaemorrhage, necrotising enterocolitis] Intrauterine infection: chorioamnionitis,puerperal sepsis. Nenatal sepsis 2-20%, mortality 5% Increased risk of maternal CS6Mechanisms of membranerupture Biochemicalprocesses ~ disruption ofcollagen matrix Programmed cell death~ apoptosis Membranes stretching Infection of reproductive tract Cytokines Prostaglandins proteina

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