PROM & PPROM Flashcards
(14 cards)
Define prelabour rupture of membranes (PROM).
Draining of amniotic fluid (rupture of membranes) before the onset of labor at ≥ 37 weeks’ gestation
Define preterm prelabour rupture of membranes (PPROM).
Draining of amniotic fluid before the onset of labor before 37 weeks’ gestation
Give 5 risk factors for PPROM.
- History of PPROM
- Short cervical length
- Antepartum bleeding
- History of sexually transmitted infections
- Prior prenatal procedures (e.g., cervical cerclage, amniocentesis)
- Low BMI
- Low socioeconomic status
- Cigarette smoking
- Substance use disorder
What is prolonged rupture of membranes?
Draining amniotic fluid for > 18 hours before the onset of labour.
How is PROM or PPROM diagnosed?
Clinical diagnosis: a sudden gush of pale yellow or clear fluid from the vagina
Sterile speculum examination
Fluid exiting the cervix and pooling in the vaginal fornix suggests rupture of membranes.
Detection of amniotic fluid
Litmus test or nitrazine test: Test strips turn blue, as amniotic fluid is alkaline.
Positive fern test: fern pattern on glass slide
Ultrasound: Oligohydramnios may be present.
What is the general care given to a woman draining liquor?
Admit patient to antenatal ward or labour ward
Monitor uterine activity and fetal heart
Check maternal PR and temperature every 4hrs
Assess for labour, chorioamnionitis and placental abruption at least daily
US for presentation, anatomy and liquor volume
How do you manage PROM?
Start Benzyl Penicillin 2MU q6h IV if PROM ≥18hours
FBC, group & save
Induce/augment labour by 24 hours after PROM if term
Caesarean delivery if previous cesarean section
How do you manage PPROM?
Send investigations: urine dipstick, urine culture if available, FBC*
If in labor administer Penicillin as above
Steroids: dexamethasone 6mg IM BD x 4 doses
If not in labor can send to ANW
How do you manage PPROM at ≥ 34weeks?
If HIV negative, induce/augment if no spontaneous labour in 24hrs ROM
If HIV positive start immediate induction, if not in labor within 24 hours consider cesarean
Deliver by cesarean section if previous cesarean section
How do you manage PPROM at 28- 34 weeks?
Expectant management
Minimise mobility; encourage leg exercises and/or anti-embolic measures
Treat with Steroids and oral antibiotics for latency: Erythromycin 250mg QID for 7days and deliver at 34 weeks gestation unless there are signs of chorioamnionitis
Admission FBC, Repeat FBC weekly or if otherwise indicated
How do you manage PPROM at 26- 28 weeks?
Consultant in put strongly recommended
US for estimated fetal weight.
Decision to continue with pregnancy discussed with patient
oConservative management: close monitoring for infection, labour or placental abruption; pelvic rest, modified bed rest with bathroom privileges, serial US, and oral antibiotics for latency.
oGive corticosteroid sat 27 weeks if patient reaches that gestation.
How do you manage PPROM at <26 weeks?
Determine GA to provide a realistic appraisal of out comes
Options to be discussed with patient:
oLabour induction with IV oxytocin and/or oral or intravaginal misoprostol
oConservative management: close monitoring for infection, labour or placental abruption, strict pelvic rest, modified bed rest with bathroom privileges, serial US, and oral antibiotics for
latency
How do you treat chorioamnionitis?
Ampicillin 1g OR Benzyl Penicillin 2MU IV q6h, plus Gentamicin 240mg daily IV until 48
hrs afebrile
If still spiking fevers add metronidazole 500mg IV every 8hrs until 48hrs afebrile
What is chorioamnionitis?
Infection of the amniotic fluid, fetal membranes, and placenta that is most commonly due to ascending cervicovaginal bacteria (e.g., Ureaplasma urealyticum or Mycoplasma hominis)
