???? (PROM and PPROM)

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???? (PROM and PPROM)

• 1. ??
• PROM ??????????????1??,??????????????
• PPROM ??37 ?,??????????????
• 2. ???
• Incidence26 ?
• 3. ?????
• ??????????,????????

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• 4. ??
• ?????????????
• Infection ??????,????ß-streptococcus(GBS)?bacteri
  al vaginosis (??metronidazole???),
  ???????????,??phospholipase A2??,?arachidonic
  acid??,??prostaglandin?????????????????,?????lysos
  omal enzyme peroxidase??????,???????????????
• ???????????????,????,?????,???????,???????????

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• 5. ???????
• History ?? time of the rupture, color of fluid,
  any discharge or blood from vagina. Sterile
  speculum exam ??? (???)
• ???????,?????????????
• ??????????????? pH4.5-5.5,?? pH7-7.5,Nitrazine
  paper?????????, ??Trichomonas, blood, semen,
  cervical mucus, urine???false positive ?
• ??????? (Ferning test)????????,???????,????????,
  
• 
  ?????????????????
• ???????????????????,???????1??,?????????
• 
  ??,????????????????????
• ???????(Sudan Stain)?????????????,????????????
• ?????????????????,????Evans blue,Indigo
  carnine,Congo
• 
  Red3.5--5cc??????,?30??????????????????
• ????????????????????,??
  ????Amnioinfusion?

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• 6. ??
• (?)????
• ??,???????
• ??????,????,???,????,?????,???????
• ??????,C-reactive protein,???????,??????????
• ???????(fetal monitor)?
• ??????,????????????

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• 6. ??
• (?)?????
• ??16-22?
• ?????????25,???????morbidity??58.5,??????????,??
  ????????????
• ??22-24?
• ??????,??????????90,??????????,???????????????,??
  ?????????
• ??25-33?
• ?????????,???????,?????????????????,?3??C-reactive
  protein,????????? (???,PG,L/S ratio -gt
  phosphotidylglecerol?lecithin and sphingomyelin)?

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• ??34-36?
• ????????,???????????????????,?????,???????????????
  ??????????????????
• ??37???
• 80--85???24???????,?Fayez???,?????24???????3.5,2
  4--48???10,??72??????40?
• ???????????????????????,????,??????,???????,??????
  ??,C-reactive protein ????,???????????????????????
  ???????????????????????????,????????????,???????,?
  ???????????,?????? (4-8???) ???????????????

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• 7. Method
• ???????????????????????????,???28???,???infection,
  ???????,???34?????????,??????????
• Intrapartum monitoring???????fetal distress????
• ????betamethasone????????,????????????
• antibiotic therapy??prolong pregnancies in
  PPROM,????Chorioamnionitis?neonatal sepsis?????
• ??delivery???,???C/S??VD,???????1500???????breech?
  ???C/S?
• Consult??????????PICU???stand by?????resuscioation
  and ??long-tern outcome,???????????????????mortal
  ity rate?

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• 8. Complication
• Pulmonary hypoplasis??????lung??????????,??extens
  ion?
• Deformation??????????,????deformity??????????????
  ,?????

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Thank you for your attention!!