PPROM

Question 1

Definition of:
PROM
PPROM

Answer 1

PROM - ROM >1hr before labour starts, after 37 weeks gestation (10%)

PPROM - ROM >1hr before labour starts, before 37 weeks gestation (2% total, 1/3 of preterm deliveries)

Question 2

Complications of PPROM

Answer 2

Pre-term delivey - 48hr in 50% cases, 80% in 7 days

Infection:

• foetal
• placenta (chorioamnionitis)
• cord (funisitis)

Question 3

Chorioamnionitis

Answer 3

Maternal pyrexia + tachycardia
Uterine tenderness/abdo pain
Foetal tachy
Speculum - offensive yellow discharge

Question 4

Examination for PPROM

Answer 4

Maternal: pulse, BP, temp, RR, O2 sats, urine analysis

Obstetric exam: soft + tender

Speculum - pool of fluid in posterior fornix (yellow and offensive), valvosa maneuver –> fluid through os

NB. do not do vaginal examination (introduce infection!)

Question 5

Investigations of PPROM

Answer 5

Infections: HVS, FBC, CRP, MSU

CTG

USS - reduced liquor (can be normal), foetal presentation, estimated foetal height

Question 6

Management of PPROM

Answer 6

Conservative management with close obnservations

<34-37 weeks:

• Give 12mg IM bethamethasone BD for 1 day
• Oral erythromycin 250mg qds for 10 days
• Admit for 24 hrs for close monitoring then MAC x 2 a week (CTG and obs)

> 37 weeks - go home and come back 24 hrs for induction of labour:
Counsel - contact details for MAC, avoiding infection (change pad every 4 hours, no tampons, no sex, no soap)