Premature Rupture of Membranes

Question 1

What is PROM?

Answer 1

Premature rupture of membranes- Spontanous rupture of membranes prior to the onset of labour at ter

Question 2

What is the aetiology of PROM?

Answer 2

Natural physiological mechanism including Braxton Hicks contractions and cervical ripening lead to weakening of the membranes.

Question 3

What is the epidemiology of PROM?

Answer 3

8%.

Question 4

What is the Hx/Exam of PROM and PPROM?

Answer 4

Sudden gush of fluid PV, followed by constant trickle.

General: assss signs of infection (fever, tachy)

Vaginal: avoid is possible to reduce risk of infeciton.

Speculum if Hx uncertain – confirm pooling of liquor in vagina, not colour.

Question 5

What Ix are good for PROM?

Answer 5

Consider microbiology fi fever suspect, HVS/LVS

Question 6

What is the management of PROM?

Answer 6

Clear liquor and no known GBS:

· Expectant management for 24h, most will labour. Offer augmentation of labour after 24h, definitely induce after 72h (with Pglandins and oxytocin infusion).

· Abx cover (benzylpenicillin or penicillin if allergic

· 4 hourly temperature and 24h fetal cardiac monitoring.

Meconium or known GBS/pyrexia: augment labour immediately (antibiotic if pyrexic or GBS+

Postnatal: observe neonate for 12h monimum.

Question 7

What are the complications/ prognosis of PROM?

Answer 7

Increased risk of ascending infection.

60% labour withini 24h.

Question 8

What is PPROM?

Answer 8

Spontaneous rupture of membranes prior to labour during pregnancy (<37wk).

Question 9

What is the aetiology of PPROM?

Answer 9

Weakening of membranes usually due to infective cause (often subclinical)

Question 10

What are the RFs of PPROM?

Answer 10

2% of pregnant woman

APH, trauma, UTI, previous PROM/PTL, uterine abnormalities, cervical incompetence, smoking, multiple, PHMN.

Question 11

What Ix do you do for PPROM?

Answer 11

Blood: FBC, CRP, WCC infection.

Micro: MSU, HVS/LVS.

CTG for fetal wellbeing, USS for anomalies, confirm presentaiton, estimate weight

Question 12

What is the management of PPROM?

Answer 12

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 PO, 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.

Question 13

What are the complications of PPROM?

Answer 13

Maternal sepsis, placental abruption.

Fetal chorioamnionitis, cord prolapse, PTL, pulmonary hypoplasia, limb contractures, death. Increased mortality due to spesis, prematurity and P hypoplasia.

NB tocolytics slow down labour:

· Atosibal: oxytocin inhibitor

· Nifedibipne: CCB

· MgSulph

· Indomethacin: NSAID

· Ritodine: B agonist, beware of many side effects