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give me 10- 15 viva questions that can be asked about an PPROM OR PROM CASE

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"Preterm Premature Rupture of Membranes"[MeSH Terms]

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ACOG prelabor rupture of membranes PROM PPROM practice bulletin patient management

  1. Define PROM and PPROM.
    • PROM is rupture of membranes before onset of labour.
    • PPROM is PROM occurring before 37 completed weeks of gestation.
  2. What is the incidence of PROM/PPROM?
  3. What are the risk factors for PPROM?
    • Previous PPROM/preterm birth, genital-tract infection, cervical insufficiency, antepartum bleeding, uterine overdistension, smoking, poor nutrition, and invasive procedures.
  4. What are the common clinical features of PROM?
    • Sudden gush or persistent leaking of clear fluid per vaginam, with decreased uterine size or reduced liquor in some cases.
  5. How will you confirm the diagnosis of PROM?
    • Sterile speculum examination for pooling of liquor, nitrazine/pH test, ferning test, and ultrasound assessment of amniotic fluid. Avoid routine digital vaginal examination.
  6. Why is a digital vaginal examination avoided in suspected PPROM?
    • It increases the risk of ascending infection and may shorten the latency period to delivery.
  7. What differential diagnoses should be considered for watery vaginal discharge?
    • Urinary incontinence, physiological leukorrhoea, vaginal infection, semen, and excess cervical mucus.
  8. What maternal complications can occur in PPROM?
    • Chorioamnionitis, maternal sepsis, placental abruption, cord prolapse, retained placenta, and postpartum endometritis.
  9. What fetal and neonatal complications can occur?
    • Prematurity and its complications, fetal distress, cord compression/prolapse, neonatal sepsis, pulmonary hypoplasia and limb deformities in very early prolonged PPROM.
  10. What clinical features suggest chorioamnionitis?
  • Maternal fever, tachycardia, fetal tachycardia, uterine tenderness, foul-smelling liquor, and raised inflammatory markers. Clinical findings are more important than any single laboratory value.
  1. What investigations will you order in a PPROM case?
  • Maternal vital signs, fetal heart-rate monitoring/CTG where appropriate, sterile speculum examination, high vaginal/cervical swab as per local protocol, urine testing, ultrasound for fetal growth, presentation and amniotic-fluid volume, and baseline blood tests if infection is suspected.
  1. How is PPROM managed before 34 weeks if there is no infection, abruption, fetal compromise, or labour?
  • Usually expectant management in hospital or a suitable monitored setting, antenatal corticosteroids, latency antibiotics, fetal and maternal surveillance, and magnesium sulfate for fetal neuroprotection when early preterm birth is anticipated according to local gestational-age guidance.
  1. What is the role of antibiotics in PPROM?
  • They reduce ascending maternal and neonatal infection and can prolong the latency period. The exact regimen should follow local obstetric protocol. Avoid amoxicillin-clavulanate/co-amoxiclav in PPROM because of an association with neonatal necrotizing enterocolitis.
  1. When should delivery be expedited in PPROM?
  • Chorioamnionitis or maternal sepsis, non-reassuring fetal status, placental abruption, cord prolapse, established labour, or other maternal/fetal indications. Timing in stable late-preterm PPROM depends on gestational age and local guidance.
  1. How does management differ in term PROM?
  • At term, induction of labour is generally recommended rather than prolonged expectant management, because infection risk rises as the duration of membrane rupture increases.
For viva, lead with the distinction: PROM is before labour; PPROM is before labour and before 37 weeks. Current guidance also highlights particularly high maternal risk in previable/periviable PPROM, requiring early senior obstetric and neonatal counselling. ACOG guidance and a 2026 systematic review of guidelines support gestation-specific management.

A PATIENT COMES WITH THE REGULAR CONTRACTIONS. LIST OUT 10 15 VIVA QUESTIONS

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"Labor, Obstetric"[MeSH Terms]

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ACOG first and second stage labor management diagnosis active labor regular contractions

For a patient presenting with regular painful uterine contractions, the likely viva case is labour in progress. Common viva questions:
  1. What is the diagnosis in this patient?
    • Labour in progress, provided contractions are associated with progressive cervical effacement and dilatation.
  2. Define true labour.
    • Regular painful uterine contractions of increasing frequency, duration and intensity, causing progressive cervical effacement and dilatation.
  3. How will you differentiate true labour from false labour?
    • True labour contractions are regular, intensify, and cause cervical change. False labour contractions are irregular and do not cause progressive cervical dilatation.
  4. What points will you ask in history?
    • Gestational age, onset/frequency/duration of contractions, leaking or bleeding per vaginam, fetal movements, previous obstetric history, antenatal complications, and medical/surgical history.
  5. What is the normal frequency, duration and strength of uterine contractions in established labour?
  6. What examination will you perform on admission?
    • General examination and vitals, abdominal examination, fetal heart-rate assessment, uterine contractions, and sterile vaginal examination when indicated.
  7. What do you assess on abdominal examination in a woman in labour?
    • Fundal height, lie, presentation, position, engagement of presenting part, liquor, uterine scar tenderness, contraction pattern, and fetal heart rate.
  8. What are the components of a per-vaginal examination in labour?
    • Cervical dilatation and effacement, cervical position and consistency, membrane status, presenting part and position, station, caput, moulding, and adequacy of pelvis.
  9. What are the stages of labour?
    • First stage: onset of true labour to full cervical dilatation.
    • Second stage: full dilatation to delivery of the baby.
    • Third stage: delivery of baby to delivery of placenta and membranes.
    • Fourth stage: immediate postpartum observation period.
  10. What is the active phase of the first stage of labour?
  • It is the phase of established labour with progressive cervical dilatation. Current obstetric guidance generally considers active labour from around 6 cm cervical dilatation.
  1. What is a partograph and why is it used?
  • A graphical record of labour progress, fetal condition and maternal condition. It helps identify slow progress and guides timely intervention.
  1. What maternal and fetal parameters should be monitored during labour?
  • Maternal pulse, BP, temperature, urine output/protein/ketones, contractions, vaginal findings; fetal heart rate, liquor, moulding and caput.
  1. What is prolonged labour? What are its causes?
  • Labour that progresses abnormally slowly. Causes can be grouped as the 3 Ps:
  • Power: inadequate uterine contractions
  • Passenger: large fetus, malpresentation, malposition
  • Passage: contracted pelvis or soft-tissue obstruction
  1. What is obstructed labour? What are its signs?
  • Failure of descent of the presenting part despite strong contractions because of mechanical obstruction. Signs include poor descent, caput/moulding, maternal exhaustion, dehydration, tachycardia, bladder distension, Bandl’s ring, and fetal distress.
  1. What are the indications for emergency cesarean delivery in a woman in labour?
  • Non-reassuring fetal status, obstructed labour/cephalopelvic disproportion, cord prolapse, placental abruption with fetal or maternal compromise, uterine rupture, failed progress with an appropriate clinical indication, or malpresentation where vaginal delivery is unsafe.
A useful opening line in viva: “Regular contractions alone do not confirm labour. I would confirm true labour by demonstrating progressive cervical effacement and dilatation, while simultaneously assessing maternal and fetal wellbeing.” This matches the textbook definition of labour as regular painful contractions with progressive cervical change.
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