12.2b Premature Rupture of Membranes

Question 1

PROM

Answer 1

• Spontaneous rupture of amniotic sac before onset of labor

- Woman reports sudden gush or slow leak of fluid from vagina

Question 2

Preterm PROM (pProm)

Answer 2

• Rupture of membranes before 37 weeks

Amniotic Sack Ruptures Due to Weakening From

• Inflammation
• Stress from uterine contractions
• Increased Intrauterine Pressure (IUP)
• Infection of Urogenital Tract

Question 3

Chorioamnionitis

Answer 3

• Most common complication of PROM
• Bacterial infection of amniotic cavity

RISKS

• Long Labor
• Prolonged membrane rupture
• Multiple vaginal examinations
• Internal FHR Monitor
• Age
• Low socioeconomic class
• Pre-existing infections

NEONTAL RISKS

• Pneumonia, Bacteremia, Meningitis
• Respiratory distress syndrome, Cerebral Palsy
• Periventricular Leukomalacia

Question 4

Other PROM Complications

Answer 4

• Placental abruption
• Hemorrhage
• Sepsis
• Hemorrhage
• Retained Placenta

FETAL COMPLICATIONS

• Intrauterine infection
• Cord Prolapse
• Umbilical cord compression (with oligohydramnios)
• Placental abruption

Question 5

Pulmonary Hypoplasia

Answer 5

• Underdeveloped lungs. Commonly occurs when PROM happens before 20 weeks gestation

Question 6

Care Management of PROM

Answer 6

• Labor will most likely be induced depending on maternal/fetal risk
• Induction of labor recommended for 34-36 weeks gestation

BEFORE 32 WEEKS (Conservative Management)

• Daily fetal assessment
• NST/BPP
• Daily Fetal Movement Count (DFMCs)
• Monitor for infection, signs of labor, placental abruption

RECOMMENDATIONS BETWEEN 24-34 WEEKS

• Antenatal Glucocorticoids (single course)
• 7 day Broad Spectrum Antibiotics
• Magnesium Sulfate for those at risk of giving birth prematurely