PROM

Question 1

What is the incidence of preterm ( > 24w) PROM ?

Answer 1

3% of pregnancies

Question 2

What is the incidence of preterm PROM among preterm births ?

Answer 2

PROM is associated with 30 - 40 % of preterm births

Question 3

What are the main causes of neonatal mortality & morbidity associated with PPROM ?

Answer 3

Prematurity / sepsis / cord prolapse / pulmonary hypoplasia

Question 4

What is the median latency time after P PROM ?

Answer 4

7 days

Question 5

How is diagnosis of P PROM made ?

Answer 5

1- maternal history
2- sterile speculum examination
3- no AF pooling 👉 consider ILGFBP-1 + PAMG-1

Question 6

What is the role of US assessment of AF to diagnose P PROM?

Answer 6

The role is unclear

Question 7

What is required antenatally to identify infection in women with P PROM?

Answer 7

Combination of
clinical assessment ( pulse/ BP / temperature )
+ maternal blood tests ( CRP / WBCs count)
+ FHR on cardiotocography
⚠️ non of these parameters should be used in isolation

Question 8

What are the symptoms of clinical chorioamnionitis?

Answer 8

1-Lower abdominal pain
2-Abnormal vaginal discharge
3-Fever
4-Malaise
5-Reduced fetal movements

Question 9

Among maternal serum markers for predicting chorioamnionitis, which is the most informative?

Answer 9

CRP sensitivity 68% specificity 77%
⚠️ WBCs count will raise 24h following administration of steroids & return to normal baseline after
3 days

Question 10

During the management of women with P PROM, should antibiotics be given?

Answer 10

Erythromycin 250 1×4 for 10 days
Can’t tolerate erythromycin 👉penicillin
⚠️ co amoxiclav increases the risk of neonatal necrotizing enterocolitis

Question 11

What is the role of antenatal Corticosteroids in women with P PROM?

Answer 11

Offer 24 w - 34 weeks
Consider: 34-36 w
Betamethazon 12 mg 2 doses 24h apart

Question 12

What is the role of MGSO4 for neuroprotection of the baby in women with P PROM?

Answer 12

Offer 24 - 30 w
Consider 30 - 34 w
⚠️4 g IV bolus of MGSO4 over 15 minutes followed by IV infusion 1g/hour until birth or 24 hours whichever is sooner

Question 13

Should tocolytic agents be used in women with P PROM?

Answer 13

Tocolytic drugs IS NOT RECOMMENDED
⛔ increase the risk of maternal chorioamnionitis without significant benefits to the neonate ( increase the risk of low abgar score + increase the need of ventilation support)

Question 14

Can women with PPROM be monitored at home?

Answer 14

The optimal method of monitoring has not been determined
👉 decide on individual basis
If at home: assessment 1-2 times a week

Question 15

When to recommend hospital based care of women with P PROM?

Answer 15

1- P PROM before 26w
2- non cephalic presentation
3- oligohydramnios
* associated with increased risk of complications ( fetal death, cord prolapse, placental abruption)

Question 16

How to monitor the fetus in women with P PROM?

Answer 16

UD every 2 w
UA Doppler weekly

Question 17

Is there a role for amnioinfusion in P PROM?

Answer 17

IS NOT RECOMMENDED as part of routine clinical practice

Question 18

Why is women with P PROM should be offered emotional support?

Answer 18

Post traumatic stress disorder is more common
14 % antenatally
17% postpartum

Question 19

When is the appropriate time to deliver the baby in women whose pregnancy complicated by P PROM?

Answer 19

24w> 👉 should be offered expectant management until 37w
* if GBS positive 👉 delivery 34w

Question 20

How should known GBS carrier women be managed in case of P PROM?

Answer 20

IAP should be given once the labour is confirmed or induced irrespective of GBS status
+ planned delivery at 34w

Question 21

How should unknown GBS status women be managed in case of P PROM?

Answer 21

Bacteriological tests is not recommended
IAP Is recommended once the labour is confirmed or induced

Question 22

What is the benefit of administering MGSO4 in women with P PROM?

Answer 22

Reduces cerebral palsy & motor dysfunction in the offspring