pre term pre labour rupture of membranes

Question 1

P-PROM

Answer 1

the rupture of membranes prior to the onset of labour

<37 weeks

Question 2

premature rupture of membranes (PROM)

Answer 2

rupture of membranes prior to the onset of labour
from 37 weeks onwards

most women will go into labour within 24h of rupture
6% will not be in spontaneous labour by 96h
the earlier the rupture, the less likely that onset of labour will be in a specified time period

Question 3

epidemiology

Answer 3

PROM: 6-19% of pregnancies
P-PROM: 2% of all pregnancies

P-PROM is ass/ w. 40% of preterm deliveries
can lead to significant morbidity and mortality

Question 4

risk factors

Answer 4

smoking - increased risk greatest <28 weeks
previous preterm delivery
vaginal bleed at any time during pregnancy
lower genital tract infection
1/3rd of women who have P-PROM have positive amniotic fluid cultures

Question 5

presentation

Answer 5

mother may give a history of:
popping sensation
gush, and continuous watery liquid draining thereafter
damp underwear or pad

Question 6

investigations

Answer 6

digital vaginal exam will increase the risk if ascending infection
(earliest signs of ascending infection are fetal tachycardia and a slight increase in maternal temp. offensive vaginal discharge may also be present)

visible amniotic fluid draining
insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1 (but not in isolation)
regular pad checks
USS for gestational age and liquor volume

monitor temp at least 12 hourly for infection
fetal monitoring

Question 7

management

Answer 7

usually seen in hospital within 48h
after this management at home (with 4- to 8-hourly temps) may be possible for some women
prophylactic ABx - erythromycin 250mg QDS, for 10 days (or until labour if this is sooner)
DO NOT use co-amoxiclav as prophylaxis

tocolytics (to prevent labour) no longer recommended

Question 8

complications

Answer 8

3 main causes of neonatal mortality:
prematurity
sepsis
pulmonary hypoplasia

also:
umbilical cord prolapse
placental abruption
oligohydramnios
increased incidence of retained placenta and secondary PPH

Question 9

prevention

Answer 9

intravaginal progesterone and cervical cerclage (‘cervical stitch’) are used prophylactically in different circumstances

Question 10

NICE guidelines

Answer 10

previous preterm birth or loss between 16 weeks-34 weeks: intravaginal progesterone or cervical cerclage

no history should be offered intravaginal progesterone

previous P-PROM or history of cervical trauma: cervical cerclage