Ignored symptoms

I'm not sure about the category into which this blog post will fit. This is more of an educative post. 

It's going to be 4 years since I've been at NJH for my second stint. There are 2 conditions in pregnant women which I've found here that people do not take seriously. 

The first one is preterm rupture of membranes and second one, urinary tract infections. 

First - Preterm Rupture of Membranes. Over the last 2 days, I've had 4 of them. All mismanaged elsewhere. 2 of them sent home with no proper advice, leave alone antibiotics. One turned out to be so bad that the endometrium and the baby was stinking. 

Even I've found that it's very difficult to convince people that once the waters have ruptured, it is almost a irreversible thing. Two days back, we had a lady who had been leaking since 8 days. Her liquer volume had come down to dangerous levels, but she and her family just could not understand that it was dangerous for her and the baby. They only wanted us to give them some medicine to seal the leak. 

We were horrified when she opted to go back home. 

I would like advice on how to put it across to our patients. I've used many analogies . . . equating the amniotic cavity to a balloon filled with water . . . how difficult it is to close . . . ascending infection etc. etc. 

However, I've failed quite a lot of times. 

The second one - Urinary Tract Infections. Interestingly, many of our diagnoses of Urinary Tract Infections are made per-operative and retrospectively. I'm sure quite a few obstetricians will find it quite interesting. I wish I could do a study on this. 

The history is classic . . .  failure to induction. Then we do the Cesarian . . . only to find a thick bladder quite adherent to the uterine wall . . . many a time with quite a bleed when bladder is pushed down along with peritoneum. Then the history of pain of passing urine is asked for and there is it . . . they give a great history of a urinary tract infection. 

I ask them if they felt it was unusual. The usual answer I receive is . . . they were told that it is quite normal to have a bit of pain/discomfort while passing urine when one is pregnant. 

Now, as most of us know, urinary tract infection in pregnancy can be quite asymptomatic. Public health specialists have always advised screening for Urinary Tract Infections using simple tests. Although it has been advised in most primary healthcare manuals, the sad fact remains that it is hardly done in most public health facilities. 

I would be quite interested to find out the burden of neonatal loss due to these two conditions in pregnant women - Delayed diagnosis and treatment of Preterm Rupture of Membranes and Urinary Tract Infections. 

Would appreciate feedback from the experts . . .