Prelabour Rupture of Membranes

Question 1

What is prelabour rupture of membranes at term?

Answer 1

Rupture of the membranes prior to the onset of labour in women at or over 37 completed weeks gestation

Question 2

What are causes of PROM?

Answer 2

Mostly unknown
Infection of lower genital tract or amnion
Polyhydramnios
Multiple preganncy
Malpresentation

Question 3

What is conservative management of PROM? When is this carried out?

Answer 3

Up to 24 hours post membrane rupture if liquor is clear, mother is well and there are no fetal concerns.
Woman should regularly take temperature, report to labour ward if any change in fetal movements, colour of smell of liquor and avoid intercourse

Question 4

When is a woman induced after PROM?

Answer 4

IF spontaneous labour has not commenced by 24h then IOL

Question 5

What is the preferred method of IOL?

Answer 5

Vaginal prostaglandin e.g. prostaglandin E2 gel followed by oxytocin infusion if contractions have not started

Question 6

What should by done if IOL is declined after PROM?

Answer 6

Monitor fetal heart rate at 1st contact and every 24h after PROM whilst woman is not in labour
Ask her to report changes in fetal movement

Question 7

What are indications for immediate IOL after PROM?

Answer 7

Group B Streptococcus carriers
HIV carriers aiming for a vaginal delivery
Signs of chorioamnionitis
Concerns regarding fetal moment
Meconium-stained liquor
Herpes simplex genital infection

Question 8

What is management of neonate following PROM?

Answer 8

Observe at 1h, 2h and then 2 hourly for further 10 horus (12h of birth - susceptible to infection)
General well being
Chest movements and nasal flare
Cap refill
Feeding
Muscle tone
Temperature
Respirations
Heart rate

Question 9

What is overall management of Premature Preterm ROM?

Answer 9

Admission
Oral erythromycin for 10 days
Antenatal corticosteroids to mature fetal lungs
Delivery considered at 34 weeks of gestation - risk of chorioamnionitis to mother however risk of RDS in neonate - balance