Preterm labor / PROM

Personal History
Mrs a year old patient, married for years, Gravida Para + living
, she is pregnant at gestational age. She is (work) and lives in
blood group Rh .

Her partner is , y/o . He is (work) rh?

She was admitted to hospital at referred via .

This history was taken by me fifth year medical student Un. at (time) from the
patient herself who seems to be reliable.

CC: for duration

HPI:
The patient was doing well till prior to admission when she began to suffer from

Discharge type? amount? Odor? Clear?

Pain? Details of pain?

 Onset – when did the symptom start? / was the onset acute or gradual?

 Duration – minutes / hours / days / weeks / months / years

 Severity – e.g. if symptom is vaginal bleeding – how many sanitary pads are they using?

 Course – is the symptom worsening, improving, or continuing to fluctuate?

 Intermittent or continuous? – is the symptom always present or does it come and go?

 Precipitating factors – are there any obvious triggers for the symptom?

 Relieving factors – does anything appear to improve the symptoms

 Associated features – are there other symptoms that appear associated e.g. fever/malaise?

 Previous episodes – has the patient experienced this symptom previously?

Fever?

Palpitation?

Ask for risk factors :UTI? VAGINITIS, CERVCITIS ? / TRAUMA? IATROGENIC? / TWINS?
MACROSOMIA? / DM? PRECLAMPSIA? / POLYHYDRAMNOUS? / PREV HISTORY OF PROM?

Systemic Review:
Cardiovascular – Chest pain / Palpitations / Dyspnoea / Syncope / Orthopnoea /
Peripheral oedema

Respiratory – Dyspnoea / Cough / Sputum / Wheeze / Haemoptysis / Chest pain

GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal pain

/ Bowel habit

Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinence

CNS – Vision / Headache / Motor or sensory disturbance/ Loss of consciousness / Confusion

Musculoskeletal – Bone and joint pain / Muscular pain

Dermatological – Rashes / Skin breaks / Ulcers / Lesions

….

Current pregnancy:
The LMP was at and EDD at therefore she is pregnant at
gestational age.

This pregnancy was (planned, accidental ), the patient noticed that she is
pregnant by complaining from (amenorrhea,..) for days duration ,
associated with (Vomiting …..) , and pregnancy was confirmed by
(plasma, urine) pregnancy test/US at gestational age.
The pregnancy was followed up by doing US time at (hospital) and it
showed
the patient had no problems early in this pregnancy , the fetal movement was felt by the
mother at weeks gestational age.

2ND AND 3RD US?

Past obstetric History:

The past obstetric hx was uneventful except for (c.s, PTL, miscarriage ) OR

The first pregnancy came to full/pre term G.A with (SNVD, assisted Vaginal, CS) in
(year) , she spent hrs during labour at hospital. Her baby was (sex), and birth
weight was gm, with complications ( fetal or maternal). The present health is
.

The second

The third

Gynecological Hx:
The menarche was at years old, the menstrual cycle is (regular, irregular), it
occurs each days, the menstruation last days, assocoiated or not with pain
(when).

There is/no Hx of inter menstrual bleeding or post coital bleeding.

Ask about number of pads per days blood clots.

The patient was on (type of contraceptives) for months and stopped it

because complication

The patient is not aware of PAP smear.The last smear was done ago, its result was ,
she had been treated by , in (year).

Her last mammogram was in (year), its result was .

There is no concern to be discussed about her sexual activity.

 Past Medical and surgical Hx:
There is an ob/Gyn surgical hx of in (year)

There is a surgical/ medical hx of in (year)

 Thromboembolic disease – high risk for further events in following pregnancy

 Diabetes – tight glycaemic control is essential – risk of congenital defects / macrosomia
 Epilepsy – some antiepileptics are teratogenic – needs neurology input
 Hypothyroidism – TFTs need close monitoring – risk of congenital hypothyroidism
 Previous pre-eclampsia– higher risk to develop it in the current pregnancy

Hx of PID, endometriosis, STD.

Smoking, alcohol, exercise

Drug Hx
Name, dose, frequency, compliance

Allergies

Teratogenic drugs:

 ACE inhibitors
 Sodium valproate
 Methotrexate
 Retinoids
 Trimethoprim

Family Hx
Chronic dz, cancer

Pregnancy loss – recurrent miscarriages in mother and sisters

Pre-eclampsia – in mother or sister – increased risk

Social Hx
Well ventilated house

Medical insurance

Smoking?

Summary
Mrs a year old patient, G P + L pregnant at gestational age & EDD
was admitted to hospital (yesterday at ) complaining of .
 Risk factors:
1- Idiopathic

2- Previous prom

3- Chorioamnionitis

4- Vaginitis

5- Multiple gestation

6- Macrosomia

7- Trauma

8- Iatrogenic

9- Dm / preeclampsia

10- Polyhydramnios

DDX:

1- INFECTION /VAGINAL DISCHARGE

2- PHYSIOLOGICAL DISCHARGE

INVESTIGATIONS:

General: CBC US TOCO CHEMISTRY UA

SPECIFIC:
Pooling positive—clear, watery amniotic fluid is seen in the posterior vaginal fornix
Nitrazine positive—the fluid turns pH-sensitive paper blue
Fern positive—the fluid displays a ferning pattern when allowed to air dry on a microscope glass slide
Management: In Kaplan p79

Complicaltions:

1- Maternal

a. DIC DVT

b. P.SEPSIS

c. CHORIOAMIOTIS

2- FETAL

a. ARDS

b. N.ENTEROCOLITIS

c. I.V HE

d. CP

e. PDA

f. COMPRESSION ( DEFORMATION …ETC)