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Premature rupture of membrane refers to the rupture of the amniotic sac and leakage of liquor before the onset of labor pains. In primary health care settings, early identification and timely management are essential to prevent maternal and neonatal complications such as infection, cord prolapse, and preterm birth. The first step in management is careful history taking. The woman may complain of sudden gush or continuous leaking of fluid from the vagina. The color, odor, and amount of fluid should be noted. Greenish fluid may indicate meconium staining, while foul smell suggests infection. The duration since rupture is very important because the risk of infection increases after 18 hours. A general examination should be done to assess temperature, pulse, blood pressure, and fetal heart rate. Fever, tachycardia, uterine tenderness, and foul-smelling discharge indicate chorioamnionitis. Abdominal examination helps to assess fetal presentation, lie, and engagement of the head. Vaginal examination should be done with strict aseptic precautions and only if necessary, as repeated examinations increase infection risk. In primary care, digital examination should be avoided unless delivery is imminent. If the pregnancy is at term and labor starts spontaneously within a few hours, the woman can be monitored ____ _________ ____ __________ ___ ______ _________.
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