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Premature Rupture of Membranes and Preterm Labor

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Emergency Department Management of Obstetric Complications

Abstract

Preterm labor and delivery are challenging obstetric complications for any emergency physician. In the United States, preterm delivery complicates approximately one in ten births and is the cause of at least 75% of neonatal deaths, not including congenital malformations. Although the causes are often unknown, emergency physicians should be familiar with predisposing risk factors. The rate of fetal and maternal morbidity can be reduced with accurate diagnosis of preterm labor, intervention to delay preterm delivery, timely administration of corticosteroids, and in certain cases magnesium sulfate and antibiotics. When preterm rupture of membranes occurs, several complications can occur including infection, premature delivery, placental abruption, and umbilical cord prolapse. The initial management in the emergency department involves an exam, obstetric ultrasound, labs, and cultures as indicated. Fetal malpresentations should be anticipated in the setting of preterm PROM with preterm labor. Considerations should be given immediately to transport to a tertiary care center with neonatal intensive care unit, especially if less than 34 weeks gestational age. Contraindications to transport include imminent delivery, fetal or maternal distress or unstable status, or if there is no safe transport to a referral center.

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Authors and Affiliations

  1. Department of Emergency Medicine, LAC+USC Medical Center, 2051 Marengo Street, C2K115, Los Angeles, CA, 90033, USA

    Eric Wei M.D., M.B.A.

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, USC, 2020 Zonal Avenue, IRD 234, Los Angeles, CA, 90033, USA

    Lili Sheibani M.D.

  3. BerbeeWalsh Department of Emergency Medicine, University of Wisconsin, 800 University Bay Drive, Madison, WI, 53705, USA

    Brian Sharp M.D., F.A.C.E.P.

Authors
  1. Eric Wei M.D., M.B.A.
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  2. Lili Sheibani M.D.
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  3. Brian Sharp M.D., F.A.C.E.P.
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Correspondence to Eric Wei M.D., M.B.A. .

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Editors and Affiliations

  1. MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA

    Joelle Borhart

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Wei, E., Sheibani, L., Sharp, B. (2017). Premature Rupture of Membranes and Preterm Labor. In: Borhart, J. (eds) Emergency Department Management of Obstetric Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-54410-6_6

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  • DOI: https://doi.org/10.1007/978-3-319-54410-6_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54409-0

  • Online ISBN: 978-3-319-54410-6

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