Q: 39 year old primi had Amniocentesis for karyotyping . presents with suspected rupture of membranes at 17 weeks. Outline management
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A : Risk associated with amniocentesis fetal loss of 1%,minor risk of abdominal pain,infection &neonatal respiratory distress syndrome
I would like to know the reasons for Amniocentesis ,was any suspicion of lethel anomalies on uss ,increase MSAP ARE ASSOCIATED WITH INCREASE RISK OF MISCARRIAGE. 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 abdominalpain , 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.
Posted by adnan S.
Dear Dr Paul
Thank you ,I took this question because confused in putting the plan, at 17 wk suspected rupture of membranes after amniocentesis. Please help.
Posted by adnan S.
Dear Dr Paul
I dint find answer to my this question either from from notes or essays please help to plan this answer .I will be greatful to you.
with regards
Adnan
