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.
