Is amniotic fluid quantitation of value in the diagnosis and conservative management of prelabour membrane rupture at term?

Article Abstract:

Premature rupture of membranes (PROM) lowers the amount of amniotic fluid surrounding the fetus. In some cases this condition will stimulate the onset of labor. When this protective barrier is compromised, the risk of uterine infection is increased. The management of pregnancies with PROM that do not progress directly to labor can be complicated. Conservative management strategies involve a wait and see approach. In an effort to prevent an intrauterine infection, the number of internal vaginal examinations should be limited. However, when internal exams are reduced, it is difficult to predict the onset of labor, which is normally assessed by progressive changes in the cervix. Ultrasonography, the use of high frequency sound to visualize internal structures, can be helpful in measuring the pockets of amniotic fluid surrounding the fetus. Pregnancies complicated by PROM rarely have extreme amniotic fluid loss, since the drainage is either intermittent or stops completely. To see if ultrasonographic measurement of the amniotic fluid is useful in diagnosing PROM and predicting the progression of labor, 151 women suspected of PROM were studied. All the women had suspected PROM for more than 10 hours. In 100 patients PROM was confirmed by testing the fluid that had pooled inside the vagina. There was no difference between the average depth of amniotic fluid in the patients with confirmed PROM and the measurements taken in the 51 patients with unconfirmed PROM. Five percent of the women with confirmed PROM and 5.8 percent of the unconfirmed cases had low average amniotic fluid depths of less than 30 millimeters. The amount of amniotic fluid measured was not related to the onset of labor, the length of time in labor, or the need to use agents that augment labor. It is concluded that ultrasonographic determinants of amniotic fluid are not useful in confirming or treating PROM. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Abnormalities, Measurement, Fetal membranes, Premature rupture of membranes, Premature rupture of the membrane, Premature labor, Amniotic fluid

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The miscarriage clinic: an audit of the first year

Article Abstract:

Miscarriage is one of the most common complications of pregnancy. The grief that is felt following a miscarriage can be extremely profound and difficult to over come. In 1989, a hospital in Ireland established a program called the miscarriage clinic, to provide counseling for women who have a miscarriage. This article describes the results of the first year of operation of this clinic. During first the year, 381 women who had miscarriages were referred to the clinic for counseling. Seventy-nine percent of the women who were referred, attended the clinic. The main difference between the women who attended the clinic and those who did not was whether or not the pregnancy had been planned. Sixty-five percent of the women attending the clinic had planned their pregnancy, while only 33 percent of those who did not attend the clinic had planned their pregnancies. Only 4 percent of the women who attended the clinic said that they felt no grief after their miscarriage, 75 percent said that their grieving resolved within one month, and 21 percent said that they were still grieving. No factors were identified that could predict the length of the grieving period. It is concluded that there is a need for miscarriage clinics to provide psychological support to couples who experience miscarriage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bereavement

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Should follow-up be provided after miscarriage

Article Abstract:

Although the psychological consequences of recurrent miscarriage have been studied, little is known about the effect of isolated miscarriages. Of the 57 women having scheduled follow-up interviews six weeks after pregnancy loss, 42 attended. Of these, 4 out of 25 women (16 percent) without any children and 26 out of 47 with other children (55 percent) refused the follow-up interview. Many symptoms of depression such as loss of appetite, tiredness, irritability, tearfulness, and difficulty sleeping were present immediately after the miscarriage. Although many of these symptoms were resolved by follow-up, 50 percent of the women still experienced tearfulness and 29 percent remained unusually tired. Most of the women were anxious about future pregnancies. Although 32 women (76 percent) had strong support during the event, 10 felt their husbands lacked understanding. Many women felt that the medical care was inadequate (21 percent) and they were unprepared for what actually occurred. Psychological support for future pregnancies and more information regarding the diagnosis of a miscarriage is suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

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