Prelabor rupture of membranes: The Daily PANCE Blueprint

Home Prelabor rupture of membranes: The Daily PANCE Blueprint

Prelabor 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. The nitrazine test is positive. FHR is reassuring. Which of the following is the most likely diagnosis?

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

Answer and topic summary

The answer is A. Prelabor rupture of membranes

Prelabor 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. The diagnostic work-up includes a sterile speculum exam (which will reveal pooling), a positive nitrazine test, and a 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) ⇒ Prelabor rupture of membranes

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

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