Premature rupture of membranes (PROM) (Complete)

Question 1

Define premature rupture of membranes (PROM)

Answer 1

Rupture of membranes at least one hour before the onset of contractions in a pregnancy at term

Question 2

What are the main clinical features of PROM?

Answer 2

Gush or slow trickle of clear or pale yellow fluid from the vaginal

No contractions

Question 3

What differentials should be considered alongside PROM?

Answer 3

Urinary incontinence

PPROM

• Less than 37 weeks gestation

Cervicitis or vaginitis

• Purulent watery discharge

Chorioamnionitis

• Foul-smelling, discoloured amniotic fluid

Question 4

What are the main complications of PROM?

Answer 4

Chorioamnionitis

Sepsis

Question 5

What investigations should be considered in women with suspected PROM?

Answer 5

Bedside:

Pregnancy/abdominal exam: Check for any tenderness or malpositioning

Speculum examination

• Check for pooling of amniotic fluid

Vaginal swabs

• Placental alpha microglobulin-1 protein (aka AmniSure) OR IGFBP-1
• Infection screen

Imaging:

CTG: Check for signs of foetal distress

Ultrasound: Check for oligohydraminos

Question 6

How are patients with PROM managed?

Answer 6

If presenting within 24 hours of initial symptoms:

Admit and observe for up to 96 hours

• 60% of patients undergoe labour within this timeframe

If presenting over 24 hours of initial symptoms:

Induction of labour

Monitoring:

24 foetal monitoring (CTG)

Monitor for signs of sepsis/chorioamnionitis (e.g. fever)