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Obstetrics
prenatal care
premature rupture of membranes
A 28-year-old gravida 2, para 1 woman at 34 weeks and 6 days gestation presents to the antenatal ward with complaints of a sudden gush of clear vaginal fluid occurring approximately 2 hours ago, followed by irregular mild uterine contractions. She reports no fever, chills, or foul-smelling discharge. Her previous pregnancy was full-term with no complications. She has a history of gestational hypertension managed with lifestyle modifications. On examination, her temperature is 37.3°C, blood pressure is 130/75 mmHg, pulse 92/min, and respiratory rate 16/min. Speculum examination reveals pooling of clear fluid in the posterior fornix, with a positive nitrazine test. The cervix is 1 cm dilated and 50% effaced. Fetal heart tones are reassuring at 145 bpm. Transabdominal ultrasound confirms adequate amniotic fluid index but does not reveal gross placental abnormalities. Urine dipstick analysis is negative for leukocytes and nitrites. Considering her presentation, what is the most likely diagnosis, the immediate management strategy, and a significant potential complication if not appropriately intervened?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Hemoglobin | 120 g/L | 115-155 g/L |
| White Blood Cell Count | 7.2 x 10^9/L | 4.5-11.0 x 10^9/L |
| Platelet Count | 205 x 10^9/L | 150-450 x 10^9/L |
| C-reactive protein (CRP) | 3 mg/L | < 5 mg/L |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Chloride | 100 mmol/L | 98-106 mmol/L |
| Potassium | 4.3 mmol/L | 3.5-5.1 mmol/L |
| Bicarbonate | 24 mmol/L | 22-28 mmol/L |
| Blood Urea Nitrogen (BUN) | 6 mmol/L | 2.5-7.1 mmol/L |
| Glucose | 5.5 mmol/L | 3.9-6.1 mmol/L |
| Creatinine | 97 umol/L | 53-106 umol/L |
| Calcium | 2.4 mmol/L | 2.1-2.5 mmol/L |
| Lecithin/Sphingomyelin (L/S) ratio in amniotic fluid | 1.6 | > 2.0 indicates maturity |
| Phosphatidylglycerol (PG) in amniotic fluid | Absent | Present indicates maturity |
| Aspartate Aminotransferase (AST) | 12 U/L | 10-40 U/L |
| Alanine Aminotransferase (ALT) | 10 U/L | 7-56 U/L |
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