Q: 39 year old primi had Amniocentesis for karyotyping . presents with suspected rupture of membranes at 17 weeks. Outline management.
A : I would like to know the reasons for Amniocentesis ,was any suspicion of lethel anomalies on uss. I would like to take history of vaginal discharge, Is it scanty or profuse, is it increasing on coughing , any associated foul smell. History of abdominal pain, bleeding PV. History of fever, not feeling well.
On examination temp, pulse, BP should be checked, PA size of uterus tenderness,fetal hearts sound. P/S.For confirmation of ROM , any foul smell to be noted, at the same time HVS is taken. VE is avoided as there is risk of introducing infection.
I will request the following investigations
FBC,CRP,USS to asses, liquor volume & feutal wel being.
If there is no signs of ROM , USS showing normal liquor, I will re-assure her .
If HVS is +ve, antibiotics given depending on sensitivity .
If signs of ROM I will observe her & give her antibiotics for 48 hrs.If there is no signs of progress or aboration or signs of infection she can be followed up in the out patients clinics with monitering of WBC count & CRP twice weekly & USS once a week, tamp twice a day. I will inform her any signs of infection like fever, not feeling well & abdominal pain is to reported.
If any signs of infection , termination of pregnancy is considered
