OGCO-C3.6 Preterm pre labour rupture of membranes Flashcards
What are the Ix and management of PPROM?
What is the Mx of PPROM <34 weeks without evidence of intrauterine infection?
- Allow pregnancy to continue with expectant management
- NST on alternate days/daily to monitor fetal well being and uterine contraction. Fetal tachycardia is highly suggestive of intrauterine infection
- Monitor maternal pulse, temp, every 4-6 hours
- Blood x CBC, CRP daily
- Tocolytics and corticosteroids therapy (lung maturation) decided by senior staff
- Antibiotics given regardless of GBS results taken within the preceding 5 weeks. Oral erythromycin 250mg q6h for 10 days and IV ampicillin 2g q6h for 48 hours followed by oral amoxicillin 250mg q8h for 5 days.
If the genital swabs taken on admission are positive for GBS< the above antibiotics regimen should be completed.
If the genital swabs taken on admission are negative for GBS< then the antibiotics regimen can be continued as follows. Complete the IV antibiotic for 48 hours then followed by completion the whole course of oral erythromycin.
What is the Mx of PPROM <34 weeks without evidence of intrauterine infection after reaching 34 weeks?
- Options of expectant management vs induction of labour should be re-evaluated with senior staff
- Expectant management till 37 weeks can be considered if there is no concern with maternal or fetal wellbeing (e.g. GBS colonization, chorioamnionitis, maternal hypertension, monochorionic multiple pregnancy).
- Timing of birth should be discussed with each woman on an individual basis with careful consideration of patient preference and ongoing clinical assessment.
- Neonatal team should be informed about the use of steroids and antibiotics.
What is the Mx of PPROM =>34 weeks without evidence of intrauterine infection?
What is antibiotics prophylaxis for PPROM in patient with penicillin allergy?
What is the flowchart for Mx of PPROM <34 weeks?
