p_prom_flashcards
What is P-PROM?
Preterm premature rupture of membranes in the absence of any uterine activity, i.e., rupture of membranes and no contractions before 37 weeks gestation (24+0 to 36+6 weeks).
What is the first step in managing P-PROM?
Admit to antenatal ward to perform sterile speculum examination to look for pooling of amniotic fluid.
What prophylactic antibiotic is offered first line for P-PROM?
Oral erythromycin 250mg QDS for a maximum of 10 days or until the woman is in established labour, whichever is sooner.
What is the second line prophylactic antibiotic for P-PROM?
Oral penicillin.
What is required for intense clinical surveillance in P-PROM?
Monitoring for signs of chorioamnionitis and pre-term labour.
What is the best practice for surveillance within Imperial NHS trust for P-PROM?
Admit until 28 weeks, after which 2-3 times per week outpatient monitoring until delivery.
What medication is offered to accelerate foetal lung maturation in P-PROM?
Maternal corticosteroids (IM betamethasone 24mg in 2 divided doses 12 hours apart).
How many courses of maternal corticosteroids should be given in P-PROM?
No more than 2 courses, discuss benefits and risks with the woman prior to administration.
When is IV magnesium sulphate offered in P-PROM?
For neuroprotection of the neonate if birth is expected within the next 24 hours.
Why should tocolytics not be administered in P-PROM?
Due to increased risk of infection.
When is delivery advised in P-PROM?
If lung maturity is confirmed, or clinical evidence of infection appears.
When should IOL not be offered in P-PROM?
Do not offer IOL before 34+0 weeks if neither lung maturity is confirmed nor clinical evidence of infection is present.
What should be done if P-PROM occurs after 34 weeks with positive group B strep?
Offer immediate IOL.
What are the risk factors for P-PROM?
Smokers, STI, previous P-PROM, multiple pregnancy.
What should be explained to the patient regarding admission for P-PROM?
The need for admission.
What are the risks of P-PROM that should be explained to the patient?
Infection which can cause damage to the baby and the use of antibiotics.
What are the risks of prematurity that should be explained to the patient?
The need to balance keeping the baby inside for as long as possible with the risk of infection.
What is the importance of close monitoring in P-PROM?
Monitoring includes CTG and maternal observations.
What should be explained about the role of antenatal steroids in P-PROM?
They help accelerate foetal lung maturation.
What discussion should be had with the patient regarding the likelihood of delivery in P-PROM?
The likelihood of delivery should be discussed with the patient.
