Mx - PPROM

Question 1

PPROM occurs in 2% of pregnancies, risk factors may be

Answer 1

smoking, poor antenatal care, young maternal age, chorioamnionitis - these are not clear causes.

Question 2

The magic gestation number for management is

Answer 2

34 - Gestation less than 34 weeks, IOL NOT recommended unless additional obstetric/fetal indications
After 34 weeks, IOL may be considered - there is evidence that it reduces chorioamnionitis and maternal length of stay

Question 3

How should suspected PPROM be managed?

Answer 3

1) Confirm PPROM with sterile speculum exam, NOT VE
2) Steroids to promote fetal lung maturity - betamethosone 11.4mg IM x2, 24 hours apart
3) Antibiotics as per ORACLE trial - erythromycin
4) Consider tocolytic (nifedipine) to facilitate transfer to tertiary centre or to allow time for steroid administration