PPROM Flashcards
What timeframe is PPROM?
<34 weeks
When does PROM start?
> 36 weeks
What happens if <24 weeks?
Pre-viable
What’s considered a prolonged ROM and what do you do?
> 18 hours
Given benzylP + induce via oxytocin
Diagnosis of PROM?
Hx and clinical exam
‘‘Pad check’’
Confirmed via sterile speculum exam and evidence of pooling of amniotic fluid in the posterior vaginal fornix
Amnisure
If <37 weeks, what are the risks?
Prematurity
Cord prolapse
Chorioamnionitis
Lung Hypoplasia
RF’s for PPROM
hubert og is a SCAMPI and was premature
Spontaneous/ Smoking / Socioeconomic status
Cervical incompetence / short cervical length
APH / African / Abruption
Multi pregnancy
Polyhydramnios / Prev PPROM /
Infection - GBS OR idiopathic OR iatrogenic
S&Ss of PPROM
Pain, fever, bleed, reduced FM
Gush of fluid w/ trickle
Green colour of liqour = meconium
Hx of preterm delivery
Hx of LLETZ procedures
Complications of PPROM
PSP
Pulmonary Hypoplasia
Sepsis
Prematurity + reduce lung surfactant
Hypoglycemia
Hypothermia
PVL
IVH
Prolapse cord
PPH
Management of PPROM if <34 weeks
Steroids
Erythromycin PO 10 days + IV BenzylP until HVS clear
What can be given for neuroprotection in PPROM?
Magnesium
Investigations for PPROM
VITALS
Microbiology - HVS
US
CTG - Fetal wellbeing
What is the goal of management of PPROM
Increase fetal maturity while reducing risk of infection & sepsis. Steroids are essential.
Principles of management of PPROM
- Admit after 24 weeks
- Steriods
- Abx
- US growth monitoring every 2/52
- Magnesium IV if delivery imminent <32 weeks
Signs of chorioamnionitis
Foul smelling vaginal fluid
Contractions
Uterine tenderness
Pyrexia, tachycardia
Management of PPROM
Bloods - FBC, CRP, CTG BD, US doppler
IV fluids + analgesia
Determine fetal position
Amnisure + HVS
Monitor temp + HR
Is it safe to do speculum exam in PPROM?
Yes - important to confirm presence of fluid in posterior fornix. Do not do digital vaginal exam due to risk of infection.
What is the likely cause of fetal distress following PPROM, especially with breech or transverse lie?
Cord prolapse
Name four respiratory complications that may affect a premature baby born after PPROM.
- TTN
- NRDS
- Bronchopulmonary dysplasia
- Long term respiratory disorders
What are the key differential diagnoses for rupture of membranes (ROM)?
- APH
- Bloody show
- Urinary incontinence
- Vaginal discharge
What are the seven key things that must be assessed on ultrasound when managing a patient with PPROM?
- FHR + Fetal movements
- Fetal weight
- Presentation
- AFI
- DVP
- Placental location
- Umbilical doppler
What conditions must be met before administering oxytocin for labor induction after PPROM?
- Intervene at 24 hours with oxytocin ONLY if:
- Baby is cephalic
- No GBS
- No fetal distress
- No maternal fever
What is the drug regimen for corticosteroids in patients with PPROM who are less than 37 weeks gestation?
Betamethasone IM 12mg, 2 doses 24 hours apart.
Dexamethasone IM 12mg, 2 doses 12 hours apart
When should erythromycin or benzylpenicillin be administered in patients with PPROM?
- Erythromycin 250mg orally QDS prophylaxis in all PPROM for 10 days
- BenzylP should be given if ROM >18 hours.
Define PPROM
Preterm, premature ROM (<37 weeks)
What is the difference between PPROM and PROM?
PROM = ROM before onset of labour and can occur at any gestation
What gestational week should not be exceeded in PPROM?
37 weeks - should be induced or C section
What do you not give if ROM has occured?
Tocolytics - Do not stop or slow down labour.
