2019 73 PPROM from 24/40

Question 1

** How should SROM diagnosis be made? **

Answer 1

Hx & sterile speculum examination
Either pooled amniotic fluid or test
IGFBP-I or PAMG-1

Question 2

** What is the antibiotic regime for PPROM? **

Answer 2

Erythromycin 250mg QDS for 10 days
Penicillin if intolerant, but not co-amoxiclav due to NEC risk

Question 3

** When are steroids used with PPROM? **

Answer 3

1. Offer 24+0 to 33+6
2. Consider up to 35+6

Question 4

** How is chorioamnionitis diagnosed in PPROM? **

Answer 4

Clinical assessment
CRP & WCC
Fetal heart rate

Question 5

** When should expectant management be used in PPROM? **

Answer 5

24 to 37 weeks

Question 6

** When should magnesium sulphate be used in PPROM? **

Answer 6

24+0 to 29+6
If established labour or preterm birth within 24 hours

Question 7

What proportion of pregnancies are complicated by PPROM?

Answer 7

3%

Question 8

What proportion of preterm births are associated with PPROM?

Answer 8

30-40%

Question 9

What complications can result from PPROM?

Answer 9

1. Prematurity
2. Sepsis
3. Cord prolapse
4. Pulmonary hypoplasia
5. Chorioamnionitis
6. Placental abruption

Question 10

What is the median latency after PPROM?

Answer 10

7 days overall
8-10 days at 24-28/40
5 days from 31/40

Question 11

How should PPROM be monitored?

Answer 11

Once to twice weekly
Clinical observations
Blood tests
CTG

Question 12

What are the benefits of antibiotics in PPROM?

Answer 12

1. Chorioamnionitis (significant)
2. Babies born within 48 hours (sig)
3. Neonatal infection
4. Use of surfactant
5. Oxygen therapy
6. Abnormal cerebral ultrasound

Question 13

What risks do steroids reduce in PPROM?

Answer 13

Respiratory distress syndrome
Intraventricular haemorrhage

Question 14

What risks does magnesium sulphate reduce?

Answer 14

Cerebral palsy
Motor dysfunction

Question 15

In which women with PPROM should hospital admission be recommended?

Answer 15

All 3 of:
1. <26/40
2. Non-cephalic
3. Oligohydramnios