A Primipara complains of sudden onset vaginal discharge at 32 weeks of pregnancy.P/A = No contractionsCephalic presentationFetal heart sounds = NormalWhat is the first step in management?
**Core Concept**
Preterm rupture of membranes (PROM) is a common obstetric emergency characterized by the spontaneous rupture of fetal membranes before 37 weeks of gestation. The presentation of a primipara (a woman in her first pregnancy) at 32 weeks with sudden onset vaginal discharge raises suspicion for PROM.
**Why the Correct Answer is Right**
The first step in managing PROM is to confirm the diagnosis and assess the fetal well-being. Digital vaginal examination should be avoided in the initial assessment to prevent infection. Instead, a sterile speculum examination is performed to confirm the presence of amniotic fluid. The next step involves assessing fetal well-being through non-stress test (NST) or biophysical profile (BPP) to determine the need for immediate delivery.
**Why Each Wrong Option is Incorrect**
* **Option A:** Immediate digital vaginal examination is not the first step in managing PROM as it can introduce infection into the birth canal.
* **Option B:** Ultrasound examination is not the initial step in managing PROM; it is used to assess fetal well-being and confirm the diagnosis.
* **Option D:** Immediate delivery is not the first step in managing PROM unless there are indications of fetal distress or maternal or fetal compromise.
**Clinical Pearl / High-Yield Fact**
In cases of PROM, the risk of infection increases with the duration of membrane rupture. Therefore, prompt delivery is often necessary to prevent maternal and fetal complications.
**Correct Answer: C. Confirm the diagnosis and assess fetal well-being.**