O&G management of PPROM

Question 1

What is PPROM associated with?

Answer 1

Preterm labour
* Cord prolapse
* Placental abruption
* Intrauterine infection/chorioaminionitis
* Pulmonary hypoplasia
* Limb positioning defects
* Perinatal mortality

Question 2

What is PPROM often associated with?

Answer 2

Subclinical infection

Question 3

What examinations and assessments do you perform for suspected PPROM?

Answer 3

• Vitals
• Abdo exam
• Uterus exam
• Sterile speculum without gel
• High vaginal swab
• MSU
• CBC and CRP
• CTG and US

Question 4

What is the inpatient management of PPROM?

Answer 4

• 72hr admission with 4hrly obs reduced to 8hrs if MEWS remain 0
• CRP
• FBC

Prophylactic antibiotics
- Erythromycin

If labour probable:
- Corticosteroids if indicated
- MgSO if <30 weeks
- Tocolysis not recommended

Question 5

What features are required for diagnosis of chorioamnionitis?

Answer 5

Vitals:
- Maternal pyrexia
- Tachycardia
CBC:
- Leucocytosis
Exam:
- Uterine tenderness
- Offensive vaginal d/c
- Fetal tachycardia

Question 6

What are the antibiotics in labour to use regardless of group B strep status?

Answer 6

<37 weeks gestation:
- Amoxicillin
With signs of infection:
- Gentamicin and metronidazole

Replace penicillin component with:
- Cephazolin (low risk ana)
- Clindamycin (high risk ana)