Lesson premature rupture of the amniotic fluid, immature rupture of...

2021-03-20 12:00 AM

The opinion about the early rupture of amniotic fluid before 37 weeks is still controversial. In many countries around the world, the concept of premature rupture of membranes or premature rupture of membranes is just one and is defined as ruptured amniotic fluid.

General perception

Premature rupture of membranes and premature rupture is a common occurrence in pregnancy and increases perinatal mortality. If the amniotic fluid breaks early when the fetus is nearly full month or a few hours before labor, the risk to the mother and the baby is less.

In contrast, premature rupture of the membranes, the earlier when the gestational age becomes premature, the consequences will lead to infection, premature birth and lack of oxygen more severe.

The opinion about early rupture of amniotic fluid before 37 weeks is still controversial. In many countries around the world, the concept of premature ruptured or premature rupture of amniotic fluid is only one and is defined: ruptured amniotic fluid is the tearing of the amniotic membrane (including the endometrium and mesothelioma) at the lower end of the egg before labor. This definition is based on anatomy and time development. Some authors also include this definition of cases of high tearing amniotic membranes. In fact the high tear amniotic membrane is rare and if it does, it also spread downwards.

In Vietnam, this concept is divided into two categories: premature ruptured amniotic fluid, which is ruptured amniotic fluid in labor and when the cervix has not been fully opened; while premature ruptured membranes are the ones that rupture without labor. If after one hour of rupture of the amniotic fluid, and still have not had labor, it is called premature rupture of the amniotic fluid.

In terms of time, premature rupture of membranes is defined as compared with the time of commencement of labor, regardless of gestational age.

Pkyles recommends identifying only premature ruptured amniotic fluid as more important because it can lead to dangerous consequences for the mother and fetus, so cases of premature rupture of membranes should be closely monitored for management. suitable.

Causes of disease

Dynamic measurement studies performed on the amniotic membrane show that the tension of the amniotic membrane in normal state is much greater than the pressure it is subjected to. Only when the fetus is nearly full month that people can observe a decrease in the worms of the amniotic membrane to facilitate the rupture of the amniotic fluid naturally. According to some authors, premature rupture of membranes is the result of either mechanical or infection.

All factors that interfere with the alignment of the fetus can be the cause of premature rupture of amniotic fluid, premature rupture of the amniotic fluid: abnormal fetal position (horizontal throne, buttock, crown of high head, multiple pregnancy, poly amniotic fluid ... .), due to striker vegetables, uterine cleft. Amniocentesis is caused by infections in the vulva of the vagina, cervix. In these cases, uterine contractions and amniocentesis cause rupture of the amniotic membrane. There are also a number of other favorable factors such as premature rupture of amniotic fluid that is doubled in the cases of pregnant women with older children, vitamin c deficiency also facilitates premature rupture of the amniotic fluid. However, in some cases the cause is also not found.

Evolution and consequences

In most cases spontaneous labor occurs after the rupture of the amniotic fluid. The time from the time of rupture of the amniotic fluid to the time of labor is called the latent period, in cases of near term or full term this time is less than 24 hours, while in the case of preterm pregnancy this period is longer. . Amniocentesis is an infection of amniotic fluid and amniotic fluid. The amniotic fluid works to prevent bacteria from entering the vagina and vulva. When the amniotic membrane ruptures this protective effect can no longer lead to an infection of the amniotic fluid. The rate of infection with the amniotic fluid becomes higher the longer the rupture of the amniotic fluid is. Amniocentesis will lead to fetal infection, fetal failure, in the postpartum period it is easy to get a postpartum infection of different degrees, if severe it can lead to peritonitis or sepsis. In some cases the fetus is not well-adjusted, the ruptured amniotic fluid can lead to a prolapse of the vegetable cord,

The prognosis for the mother depends on whether there is an amniotic fluid infection or not, the prognosis for the baby is often bad because of the preterm baby, neonatal infection, and respiratory failure.

Diagnose

Implementing the quadrants

Identifying early rupture of membranes is not always easy. The key is to see if the amniotic fluid has ruptured for proper management. Half of the leg cases guess goats easily due to a lot of amniotic fluid, sometimes mixed with substances.

Ask the medical history about the properties of amniotic fluid. In typical cases, pregnant women report sudden discharge of water, sometimes with both substances. After the release, the water will continue to come out after that.

Examination of platypus has a lot of amniotic fluid in the vagina, amniotic fluid is flowing from the uterine hole, in case it is not clear, the pregnant woman can cough or push to see the amniotic fluid coming out.

Vaginal examination of the armband when the uterus was opened, so that her fingers could not be felt, the amniotic fluid came out slightly when it was slightly lighter. In some cases it is very difficult if the amniotic fluid is close to the scalp. In the case of rupture of the amniotic membrane at an elevated height, on examination the vagina will reveal amniotic fluid along the hand but the amniotic membrane is intact.

If it is difficult to determine clinically, it is necessary to do some tests:

Amniocentesis: amniocentesis will not see the amniotic fluid, but the fetal hair (in the crown) and see amniotic fluid coming out.

The Nitrazine test is based on the difference between the pH of the vagina and the pH of the amniotic fluid. Use a test paper and place the same item later, if the pH is alkaline, the amniotic fluid is broken. This test is wrong when the amniotic fluid has ruptured for a long time, when there is a vaginal infection, the woman has taken antibiotics, or the urine is mixed in the vagina.

Fern test: using a cotton swab to apply amniotic fluid on a glass slide to dry and then under a microscope will give a fern-like image due to sodium chloride in amniotic fluid. The result is accurate if there is no blood in the amniotic fluid.

Look for the ingredients in the amniotic fluid: microscopic examination of the substance, fetal hair hair, or dye with special dyes such as Nil blue, acridin yellow to find the fetal epidermal cells.

Quantitative DAO (diamin oxidase) secreted by vegetables; this method is accurate to 90%.

For cases of difficult labor, it is possible for the pregnant woman to lie down and keep track of her looms.

Differential diagnosis

Urinary incontinence usually does not produce as much amniotic fluid and will not leak continuously as in rupture of the amniotic fluid.

A bad gas discharge can sometimes be mistaken for ruptured membranes.

The cervical mucus at the start of labor comes out the cervical mucus, usually with a little pink blood mixed in.

To solve

In the case of full-term pregnancy after the rupture of the amniotic fluid, spontaneous labor is often involved. If you have not had labor without signs of amniocentesis, you can wait about 6 hours to see if there are spontaneous labor. If after 6 hours, you have not had labor, you can induce labor by causing uterine contractions.

In the case of preterm pregnancy less than 36 weeks or estimated fetal weight <2000g, the postpartum mortality rate is very high, so the general tendency is to keep the pregnancy by resting the pregnant woman to avoid too much exercise, freezing the body sterile delivery, limited vaginal examination. Monitor temperature, white blood cell formula, CRP (C reactive protein), the amount of amniotic fluid through the vagina, ultrasound assess amniotic fluid and fetal status, monitor fetal status on monitoring. If there is no infection, little or no amniotic fluid stops, hopefully the fetus will continue to grow without danger. On the contrary, if there are signs of infection (fever, increased leukocytes, dirty amniotic fluid ...) or when monitoring is still seeing a lot of amniotic fluid, it is also compulsory to suspend the pregnancy.

The problem of using prophylactic antibiotics in premature rupture of membranes is still controversial. Many authors believe that prophylactic antibiotics can reduce the incidence of complications of amniotic fluid infection for the mother but not for the fetus because the drug only passes through the placenta with a very low concentration. On the other hand, antibiotic prophylaxis does not always completely prevent infection, making it difficult to detect in time to have proper management. Antibiotic treatment should only be used in cases where there is a risk, the risk may be due to the mother's physical condition such as a history of acute low grade acute depression, heart valve disease ...

Some authors recommend corticosteroids in preterm pregnancy with the aim of stimulating the maturation of fetal lungs to avoid complications of respiratory failure caused by endothelial disease. Contraceptive drugs are only effective when there are no signs of real labor. For newborns, the risk of infection is very high, so it is necessary to transplant blood and culture in natural holes. There is no need to treat infants who are not infected and are not preterm. Conversely, it is necessary to immediately transfer to the neonatology department if:

Green amniotic fluid is dirty, has a bad smell.

Mother's fever is over 38 ° c.

Respiratory failure.

Some clinical signs of infection include decreased muscle tone, splenomegaly,

dermatitis, premature jaundice ...

In summary, premature rupture of membranes is a common obstetric condition that needs to be managed early and properly to avoid early rupture of membranes due to maternal and fetal complications. Especially for preterm fetuses, consider and delicate treatment, on the one hand, it should not be too hasty to claim a preterm fetus, but not too late, it is easy to make the evidence of amniocentesis worsening. intake for mother and fetus.