5. PREMATURE RUPTURE OF MEMBRANE (PROM)

It is the rupture of membranes before labor starts resulting in cervical dilatation occurring before 37wks of gestation. It is associated with infection of the reproductive tract.

Management:  

Ask the time of rupture:  If membrane has been ruptured for more than 12hrs

• Check and record FHS

• Check the color and odor of the liquor

• Apply clean sanitary pad

• Give broad spectrum antibiotic

Cardinal Signs: Includes temperature   ˃38 degree centigrade, offensive vaginal discharge and rapid pulse.

6. FEVER: It is a mark increase in body temperature. Fever in itself is not a disease but a symptom. Any infection in pregnancy can cause fever e.g. STI, UTI, hepatitis, TB, Malaria etc.

The most common cause of fever in the tropics generally is malaria.

Malaria: It is a febrile condition caused by the plasmodium species which is transmitted by the bite of infected female Anopheles Mosquitoes. It is endemic in Nigeria and a major cause of maternal and perinatal morbidity and mortality. A positive RDT with the following accompanying symptoms should be treated;

Symptoms: 

Uncomplicated

Complicated

1. 
   Fever

2. Nausea and Vomiting

3. Muscle/ Joint pains

4. Shivering/Chills/rigors

5. Headache

6. False labour pains

7. Mild anaemia

Any of the following in addition to signs of uncomplicated.

1. Jaundice

2. Difficulty in breathing

3. Drowsiness/ sleeplessness

4. Coma

5. Severe anaemia

6. Severe dehydration.

For Effective Case Management:

1. Carry out malaria test using RDT

2. Encourage plenty of fluid

3. Tepid sponge if necessary

4. Assess whether uncomplicated or complicated (Refer)

5. Give Anti-malarial to those with positive RDT ( in the table below

6. Give analgesics

7. Advice on the following:

• Drug compliance and adverse reaction

• Use of ITN

• Environmental sanitation to prevent re- occurrence

Mild Malaria in Pregnancy

Medicine

1st Trimester

2nd Trimester

3rd Trimester

Quinine tablets

ACT

20mg/kg loading dose then 10mg/kg

8hourly x 7days 

Not recommended.

←

4 tabs bd x3 days

←

4 tabs bd x 3 days

• Quinine is considered safe in pregnancy and can be used in all trimesters.

• ACT e.g. Artemether + Lumefantime are considered safe in 2nd and 3rd trimester only.

Severe malaria in pregnancy

Medicine

1st Trimester

2nd Trimester

3rd Trimester

Quinine IV/IM

20mg/kg loading dose in 500ml 5% D/saline then 10mg/kg 8hrsly until patient can tolerate oral quinine, complete a 7 days therapy.

←

←

ACT

Not recommended

IM/IV for 3 days then oral therapy to complete 7 days

←

3.7 ELIMINATION OF MOTHER TO CHILD TRANSMISSION OF HIV

A HIV positive pregnant woman can transmit HIV to her newborn child during pregnancy, labour, delivery, and breastfeeding. In order to prevent this, WHO introduced a set of interrelated interventions designed to block transmission of HIV from a HIV infected mother to her child during the period of pregnancy and breastfeeding. These interventions are offered together as a single package of care known as Prevention of Mother to Child Transmission of HIV (PMTCT). 

ARV Intervention                                          

• Pregnancy is an absolute indication for ART. 

• ART should be initiated in all HIV pregnant and breast-feeding women regardless of WHO clinical stage and CD4+ cell count and continued for life. This is also regardless of gestational age. 

• ART should be initiated urgently in all pregnant and breastfeeding women, even if they are identified late in pregnancy or postpartum, because the most effective way to prevent mother-to-child HIV transmission is to reduce maternal viral load. 

ARV Intervention (Recommended regimen for HIV+ Women)

FIRST LINE  ART

PREFERRED FIRST-LINE REGIMEN

ALTERNATIVE FIRST-LINE REGIMEN

Pregnant or 

Breastfeeding women

TDF + 3TC + EFV

TDF + FTC + EFV

AZT + 3TC + EFV 

AZT + 3TC + NVP

TDF + 3TC + NVP 

TDF + FTC + NVP