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Definition

PROM

Premature rupture of membranes
ROM prior to labour

PPROM

Prior to labour and prior to 37 weeks
90% of Pt has some sort of infection

O/E

Uses Sterile Spec

Vaginal exam (finger) should be deferred unless patient contracting.

Physical Exam

Pooling of fluid in vagina
Cascade signs (MOST specific)
- Cough → fluid coming out of cervix

Setrile SPEC
- Fluid for Nitrazine, Microscope
- AVOID Digital vaginal exam (↑ infection risk)

Test	Utility	Positive Signs
Nitrazine (pH)	Sensitive, not specific	Amionic fluid = akaline
Microscope	Specific	Ferning Pattern*
Ultrasound - ‣		AFI < 5 (Oligohydramnios)
AmniSure/RomPlus	Highly accurate, expensive

*Amionic fluid dry → Estrogen causes it to create ferning pattern