PPROM

Question 1

What is the definition of PPROM?

Answer 1

Premature Prolonged Rupture of Membranes - SROM before 37/40 and before the onset of labour

Question 2

What are some complications of PPROM?

Answer 2

• Prematurity
• Sepsis
• Pulmonary hypoplasia
• Cord prolapse
• Malpresentation
• APH

Question 3

What is pulmonary hypoplasia?

Answer 3

Low number/size of alveoli in the lungs

Question 4

How is PPROM most commonly diagnosed?

Answer 4

• Pool of fluid seen in vagina during speculum examination

- Make women lie down for 1/2 hour before examination to allow liquid to pool

Question 5

What are some other ways that PPROM is diagnosed?

Answer 5

• Nitrazine test
• Microscopic examination
• USS for oligohydramnios

Question 6

Why is the Nitrazine test not reliable?

Answer 6

It is a pH test that also indicates vaginal secretions, semen and blood

Question 7

What does the microscopic examination look for?

Answer 7

• Ferning of crystalline pattern of dried amniotic fluid
• Presence of lanugo hair
• Foetal epithelial cells

Question 8

What else may these women present with?

Answer 8

• Abdo pain
• Back pain
• Bleeding

Question 9

How is PPROM managed?

Answer 9

• Corticosteroids
• Antibiotics
• ?Timing and method of delivery
• Inpatient vs. home care

Question 10

What is the most common antibiotic used and what is given if the woman is unable to tolerate this?

Answer 10

• Erythromycin 250mg QDS for 10 days/ until labour begins

- Unable to tolerate = Penicillin

Question 11

Which antibiotics should not be given and why?

Answer 11

Augmentin and Co-Amoxiclav as they increase the risk of NEC

Question 12

How does inpatient management work?

Answer 12

• Temp 4 hourly
• CTG, CRP and WCC daily
• USS for liquor, growth and Doppler
• MSU and HVS/LVS
• ?Discharge after 48 hours

Question 13

How does home management work?

Answer 13

• Temp QDS (to report if abnormal)
• Twice weekly review for CTG, CRP, WCC
• Fortnightly USS for growth
• Weekly USS for Doppler
• No baths, sex or tampons
• Given info regarding signs/symptoms to look for

Question 14

What are the advantages of home management?

Answer 14

• Approx. 10 fewer hospital days as an inpatient
• Decreased cost
• Psychological benefit
• Less danger of infection

Question 15

What are the disadvantages of home management?

Answer 15

• Deterioration may be missed

- Foetal monitoring only twice weekly

Question 16

What is an amnioinfusion?

Answer 16

The process of installing isotonic liquid into the uterine cavity