Premature rupture of membranes: The Daily PANCE Blueprint

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Premature rupture of membranes: The Daily PANCE Blueprint

A 23-year-old G3P1102 at 39 weeks gestation presents to the ER complaining of clear fluid leaking from her vagina for the past 20 hours. She denies contractions or vaginal bleeding. Vital signs are stable. On a sterile speculum exam, you note pooling of amniotic fluid in the vaginal fornix. Nitrazine test is positive. FHR is reassuring. Which of the following is the most likely diagnosis?

A. Premature rupture of membranes
B. Preterm premature rupture of membranes
C. Incompetent cervix
D. Placental previa
E. Prolapsed umbilical cord

Answer and topic summary

The answer is A. Premature rupture of membranes

Premature rupture of membranes is defined as the rupture of membranes occurring before the onset of labor. Risk factors include previous PROM, smoking, infection, and multiple pregnancies. A classic clinical feature is a gush of fluid from the vagina and increased discharge. Diagnostic work-up includes sterile speculum exam (will see pooling), positive nitrazine, and fern test. Treatment is delivery by the induction of labor in stable patients.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Reproductive System ⇒ Complicated Pregnancy (PEARLS) ⇒ Premature rupture of membranes

Also covered as part of the Emergency Medicine EOR and Weomen's Health EOR topic lists

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