Premature Rupture of Membranes at Term

Question 1

What is PROM

Answer 1

Leakage of Amniotic Fluid in absence of Uterine Activity, after 37/40
• 8% of Term Pregnancies; Idiopathic, Clinical/Subclinical Infection, Polyhydramnios, Multiple
Pregnancies or Malpresentation

Question 2

Presentation of PROM

Answer 2

Typically, history of sudden gush of fluid leaking from vagina, recurrent dampness or constant leaking of fluid; Speculum examination if uncertain history
o Valsalva can demonstrate leaking fluid – Note if Blood or Meconium stained
Avoid Digital Examination if conservative management planned – Increased risk of
Chorioamnionitis, Endometritis and Neonatal Infection

Question 3

Presentation of Chorioamnionitis

Answer 3

presents as Foetal or Maternal Tachycardia, Pyrexia, Rising Inflammatory Markers, Irritable or Tender Uterus
o Requires prompt treatment with Antibiotics and Rapid delivery of Foetus

Question 4

Management of PROM

Answer 4

60% will go into labour within 24hrs; 1% risk of serious neonatal infections (2-fold); If Expectant management, more likely to develop Chorioamnionitis and Endometritis if >24h;
More likely for SCBU admission but no evidence for difference in Neonatal outcome if <24h

Question 5

Expectant Management

Answer 5

Record temperatures, urgently report any change in colour/smell,
Report decreased foetal movements, Delivery in Neonatal unit, Consider induction if >24h;
Use of prophylactic antibiotics controversial

Question 6

Known Group B Strep Carrier

Answer 6

Immediate Induction encouraged; Mother offered

Benzylpenicillin in labour; Neonates screened soon after birth