12.    A 24-year-old primigravida presents at 32 weeks with a history of a large loss of clear fluid from the vagina.

a)        How would you confirm the diagnosis of PROM?

            Speculum examination and see pooling of liquor in the vagina. Do a nitrazine stick test: should turn from yellow to dark blue if it is amniotic fluid.

b)         What is the differential diagnosis? 

            1.    Urinary incontinence.

             2.    Vaginal discharge.  

c)         What investigations would you perform? Name three. 

            1.    Endocervical swab.

             2.    White blood count.

             3.    Ultrasound scan for AFI.

             4.    Mid-stream urine.

             5.    CTG.

d)         What drug treatment might you consider and why? Name three drugs.

            1.    Tocolysis if contracting.

             2.    Steroids for lung maturation.

             3.    Antibiotics for prophylaxis. 

e)         What is the percentage chance of spontaneous labor within the next 10 days?

              > 90%.