Preterm premature rupture of membranes (PPROM) Flashcards
Define PPROM.
Spontaneous rupture of membranes prior to labour during pregnancy (<37wk)
What is the aetiology of PPROM?
Weakening of membranes usually due to infective cause (often subclinical).
What are risk factors associated with PPROM?
Antepartum haemorrhage
Trauma
UTI
Previous PROM/PTL
Uterine abnormalities
Cervical incompetence
Smoking
Multiple pregnancy
Summarise the epidemiology of PPROM.
2% of pregnancies
What are signs and symptoms of PPROM?
Sudden gush of fluid PV, followed by constant trickle.
General: Assess signs of infection (fever, tachy)
Vaginal: Avoid if possible to reduce risk of infeciton.
Speculum if Hx uncertain – confirm pooling of liquor in vagina, not colour.
What investigations should be performed for PPROM?
Blood: FBC, CRP, WCC infection.
Micro: MSU, HVS/LVS.
CTG for fetal wellbeing, USS for anomalies, confirm presentaiton, estimate weight.
What is the management for PPROM?
Admit for monitoring for 48-72h. Steroids to improve fetal lung maturity. Monitor temperature 4hourly, monitor CTG . Consider tocolysis in the presence of some uterine activity only if IU transfer required or for steroid cover.
If managed as OP, weekly HVS and bloods, twice daily temperature to check infection. Aim to deliver around 34/40, or earlier if infeciton (chorioaminonitis).
If <23/40, discuss TOP.
What complications are associated with PPROM? What is the prognosis of PPROM?
Maternal sepsis, placental abruption.
Fetal chorioamnionitis, cord prolapse, PTL, pulmonary hypoplasia, limb contractures, death. Increased mortality due to spesis, prematurity and P hypoplasia.
What is the role of tocolytics?
Slows down labour:
- Atosibal: oxytocin inhibitor
- Nifedibipne: CCB
- MgSulph
- Indomethacin: NSAID
- Ritodine: B agonist, beware of many side effects
