Mx - Term PROM

Question 1

What is term PROM?

Answer 1

Prelabour rupture of membranes from 37 weeks

Question 2

How should I assess a patient with suspected term PROM?

Answer 2

1) Confirm PROM with sterile speculum examination - avoid doing VE as this can increase risk of infection
2) Confirm maternal and fetal wellbeing

Question 3

How should women with term PROM be managed?

Answer 3

Two options

1) Active mx with IOL - reduces risk of maternal and neonatal infection, increased maternal satisfaction, and no change in C/S rate or instrumental delivery.
2) Expectant mx - 70% will labour within 24 hours, 85% within 48. Women must be GBS negative, with no sign of infection, no hx VE, normal CTG with fixed cephalic presentation, reassessed 4 hourly.

Question 4

Antibiotics?

Answer 4

Benzylpenicillin (clindamycin if allergic) is indicated for GBS positive women (plus induction)
In GBS negative - abx after 18 hours.

Question 5

What method of induction is recommended?

Answer 5

Syntocinon IOL is method of choice