Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a report of sudden gush or continuous leakage of clear/pale fluid per vagina. Denies contractions, vaginal bleeding, or decreased fetal movement. Last ultrasound confirms gestational age [GA] weeks. No history of recent pelvic exams or intercourse.
Clinical Examination Findings
Vitals stable. Abdominal exam: Uterus non-tender, fetal heart rate [FHR] reactive. Sterile speculum exam: Pooling of clear fluid in posterior vaginal fornix, positive nitrazine test (pH > 6.5), and positive ferning pattern on microscopic evaluation. Cervix: [Dilation/Effacement/Station]. No evidence of cord prolapse or active bleeding.
Treatment Protocol
Admit for inpatient management. Initiate latency antibiotic protocol (e.g., Ampicillin/Azithromycin). Administer corticosteroids for fetal lung maturity (Betamethasone 12mg IM q24h x 2 doses). Consider magnesium sulfate for neuroprotection if GA < 32 weeks. Continuous FHR monitoring and daily assessment for signs of chorioamnionitis (fever, tachycardia, uterine tenderness).