[23] Pre-term Prelabour Rupture Of Membranes Flashcards
What is preterm pre-labour rupture of membranes (P-PROM)?
The rupture of membranes prior to the onset of labour in a patient who is less than 37 weeks gestation
In what % of pregnancies does P-PROM occur in?
2%
What % of pre-term deliveries are associated with P-PROM?
40%
What will happen to most women who rupture their membranes?
Most women will go into labour within 24 hours
What % of women will not go into labour within 96 hours of ruptured their membranes?
6%
What effect does the gestation at which membrane rupture occurs have on the likelihood of going into labour?
The earlier in gestation the rupture occurs, the less likely that the onset of labour will be within a specified time period
What are the risk factors for P-PROM?
- Smoking
- Previous preterm delivery
- Vaginal bleeding at any time during pregnancy
- Lower genital tract infection
How might P-PROM present?
Mother may give history of ‘popping sensation’ or ‘gush’, with continuous watery liquid draining after
Why should you not routinely perform vaginal examination in women with P-PROM?
As it will increase the risk of ascend infection
In what ways can the diagnosis of P-PROM be made?
- Visually
- Testing for specific factors
How can the diagnosis of P-PROM be made visually?
- Seeing amniotic fluid draining from cervix and pooling in vagina after woman has been lying down for 30 minutes
- Regular pad checks
How can amniotic fluid be seen draining from the cervix?
Sterile speculum examination
What factors can be tested for to aid the diagnosis of P-PROM?
- Insulin-like growth factor binding protein-1
- Placental alpha-microglobulin-1
What should be remembered when using testing for factors to aid the diagnosis of P-PROM?
Results should not be considered in isolation
What does amnioquick test for?
Insulin-like growth factor binding protein-1
What other investigations may be done in P-PROM?
- Ultrasound
- Temperature monitoring
- Fetal monitoring
Why might ultrasound be useful in P-PROM?
To check for gestation and liquor volume
How often should temperature monitoring be done in P-PROM?
At least every 12 hours
Why should temperature monitoring be done in P-PROM?
To check for ascending infection
When should you immediately refer to hospital in P-PROM?
If P-PROM is suspected, or if ascending infection is suspected
What can indicate ascending infection in pregnancy?
- Maternal or fetal tachycardia
- Pyrexia
- Abdominal tenderness
What does the management of P-PROM?
Antibiotic administration
What is the role of prophylactic antibiotics in P-PROM?
They appear to reduce complications due to pre-term delivery and post-natal infection
What antibiotic is given for prophylaxis in P-PROM?
Erythromycin
When are antenatal steroids given in P-PROM?
If gestation is 24-34+6 weeks
Are tocolytics recommended in P-PROM?
No
When should delivery be considered in P-PROM?
At 34 weeks
What should be done if the pregnancy continues over 36 weeks in P-PROM?
The mother should be informed that she is at increased risk of chorioamnioitis and a reduced risk of respiratory problems for the neonate
What can be used to prevent P-PROM?
Intravaginal progesterone and cervical cerclage
When should the need for prevention for P-PROM be considered?
When a woman has a cervical length of <25mm on transvaginal ultrasound between 16-34 weeks
What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and a previous preterm birth or pregnancy loss between 16-34 weeks?
Offer either intravaginal progesterone
What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and no history of pre-term birth or pregnancy loss between 16-34 weeks/
Offer IV progesterone
What should be done when a woman has a cervical length of <25mm between 16-34 weeks gestation, and had P-PROM in previous pregnancy or history of cervical trauma?
Offer cervical cerclage
What are the 3 main causes of neonatal mortality associated with P-PROM?
- Prematurity
- Sepsis
- Pulmonary hypoplasia
What are the other complications of P-PROM?
- Umbilical cord prolapse
- Placental abruption
- Oligohydraminos
- Increased incidence of retained placenta and secondary post-partum haemorrahge
When can P-PROM cause oligohydraminos?
If it happens early in pregnancy
