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Flashcards in Term PROM Deck (10)
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1

Define PROM at term.

Confirmed rupture of membranes prior to the onset of labour, at ≥37 weeks gestation

2

What is the incidence of PROM.

8%

3

What is the management of term PROM?

- Clinical Hx /exam / obs / bloods - check for signs of chorioamnionitis
- CTG
- Confirm gestation
- Confirm presentation
- Vaginal swab for GBS carriage
- Induction within 24 hours with prostaglandin or syntocin
- Continuous CTG in labour
- No need for routine antibiotics, if PROM <24hours
- If GBS - needs immediate IOL and GBS antibiotic prophylaxis
- If meconium / suspected chorioamnionitis for immediate IOL

4

What is the evidence for expectant versus early (<24hours) induction?

Cochrane 2017

Planned early induction <24 hours is associated with:
- reduction in maternal chorioamnionitis and endometritis (roughly 50%; RR 0.49); Absolute risk: 11-->6%
- Reduction in suspected and confirmed neonatal sepsis (roughly 25%, RR 0.73)
- Reduced neonatal antibiotic use, admission to SCBU/NICU, hospital stay
- No increase in caesarean section
- Improved maternal satisfaction

5

Compare Amnisure and Actim PROM for PROM detection.

- Amnisure 100% sensitive and specific
- Actim PROM marginally less
- Both POC tests, with quick results (<10mins)
- Both are not affected by semen and trace blood
- Can have false positives 15-30% in threatened preterm labour

6

Compare Amnisure and Actim PROM for PROM detection.

- Amnisure 100% sensitive and specific in RCT
- Actim PROM marginally less
- Both POC tests, with quick results (<10mins)
- Both are not affected by semen and trace blood
- Can have false positives 15-30% in threatened preterm labour

7

What are the early and late risks of PROM?

early
- Cord prolapse
- Cord compression
- abruption

Late
- Neonatal infection --> chronic lung disease, cerebral palsy, death
- Chorioamnionitis and/or maternal sepsis

8

What are the early and late risks of PROM?

early
- Cord prolapse
- Cord compression
- abruption

Late
- Neonatal infection --> chronic lung disease, cerebral palsy, death
- Chorioamnionitis and/or maternal sepsis

9

Is there any evidence to guide induction method?

Cochrane 2017
- Subgroup analyses
- Syntocin and SL misoprostol were associated with lower rates of infection
- Lower rates of caesarean section using SL misoprostol

10

What are risks/causes for PROM?

- Over distension of the uterus (e.g. polyhydramnios, multiple pregnancy)
- Disruption in membranes function
- Infection
- Smoking
- Frequent digital examinations
- Coitus