10/11) Labour & Delivery - PPROM

Question 1

Incidence of PPROM

Answer 1

3% of pregnancies

Question 2

What percentage of preterm births are associated with PPROM?

Answer 2

30-40%

Question 3

Risk of serious neonatal infection after PPROM

Answer 3

1% (compared to 0.5% without PPROM)

Question 4

How to confirm diagnosis of PPROM?

Answer 4

Maternal history and sterile speculum.

If liquor not seen then IGFBP-1 or PAMG-1 test of vaginal fluid.

Question 5

How often is speculum examination equivocal in PPROM?

Answer 5

10-20%

Question 6

How often should maternal observations and FHR be auscultation in PPROM?

Answer 6

Every 4-8 hours.

Question 7

Pattern of WCC changes after steroids

Answer 7

Rises in 24h after steroids but settles by D3

Question 8

Recurrence rate of PPROM

Answer 8

7-9x more likely

Question 9

Median latency of labour after PPROM

Answer 9

7 days

Question 10

Percentage of patients labouring within 24 hours of PPROM

Answer 10

60%

Question 11

Antibiotics in PPROM

Answer 11

Erythromycin 250mg QDS 10 days or until in established labour (Penicillin is an alternative if required)

Question 12

Benefits of erythromycin

Answer 12

Reduces rates of chorioamnionitis and number of babies born within 24 hours

Question 13

When to give steroids in PPROM?

Answer 13

Give up to 33+6 and consider up to 35+6

Question 14

When to give MgSO4 in PPROM?

Answer 14

Give up to 29+6 and consider up to 33+6

Question 15

Role of tocolysis in PPROM

Answer 15

Not recommended as increases risk of chorio

Question 16

Rates of PTSD after PPROM

Answer 16

14% (compared to 2% without PPROM)

Question 17

When to deliver PPROM?

Answer 17

If no contraindication then expectant management until 37 weeks. If GBS then consider from 34 weeks.