Self-Assessment Questions (SAQs) for Study Session 17

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 17.1  (tests Learning Outcomes 17.1 and 17.2)

Complete the missing information in Table 17.1.

Table 17.1

PROM classificationGestational age
Preterm PROM
Term PROM
Interval since membranes ruptured
Early PROM
Prolonged PROM

Answer

The completed Table 17.1 should look like this:

Table 17.1

PROM classificationGestational age
Preterm PROMAfter 28 weeks and before 37 weeks
Term PROMAfter 37 weeks, including post-term (after 40 weeks)
Interval since membranes ruptured
Early PROMLess than 12 hours
Prolonged PROMMore than 12 hours

SAQ 17.2  (tests Learning Outcomes 17.1, 17.3, 17.4 and 17.5)

Which of the following statements is false? In each case, explain what is incorrect.

A  Infection in the uterus may cause PROM and may also be a complication following PROM.

B  PROM may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid.

C  Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse.

D  The fetal membranes are so strong that blunt trauma to the abdomen is unlikely to cause PROM.

E  Hypoxia and asphyxia of the woman in labour is a common complication of prolonged PROM.

F  A sudden gush of clear watery fluid from the vagina is always seen in cases of PROM.

Answer

A is true. Infection in the uterus may cause PROM and may also be a complication following PROM.

B is true. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid.

C is true. Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse.

D is false. Blunt trauma to the abdomen is a common cause of PROM.

E is false. Hypoxia and asphyxia of the fetus (not the woman in labour) is a common complication of prolonged PROM.

F is false. Some cases of PROM occur without a sudden gush of clear watery fluid from the vagina, so you should always take account of other diagnostic signs such as reduction in size of the abdomen and clearly palpable fetal parts.

Read Case Study 17.1 and then answer the questions that follow it.

Case Study 17.1  Zufan’s story

Zufan’s family contact you to say that her waters broke 24 hours earlier, but they are concerned because her labour has not started yet. They think the baby was due to be born last week. She feels hot to the touch and is becoming restless and complaining of pain in her lower abdomen.

SAQ 17.3  (tests Learning Outcomes 17.1, 17.2, 17.5 and 17.6)

  • a.How do you classify Zufan’s case of PROM?
  • b.Does she have the signs of any complications?
  • c.Is there anything you could have done to prevent her condition from worsening?
  • d.What immediate action should you take?

Answer

  • a.Zufan’s condition should be classified as post-term prolonged PROM, because the gestational age is already beyond 40 weeks and her membranes ruptured more than 12 hours ago.
  • b.She has two clear signs of abdominal infection: fever and lower abdominal pain.
  • c.You could have prevented her condition from worsening if you had counselled Zufan and her family more clearly about the risks of waiting at home after the membranes have ruptured.
  • d.You should immediately refer her to the nearest hospital or health centre with surgical facilities; she will also need antibiotics quickly to treat the infection.

Summary of Study Session 17