Prelabour rupture of membranes at term Flashcards
What is the definition of prelabour rupture of membranes (PROM) at term?
leakage of amniotic fluid in the absence of uterine activity after 37 completed weeks of gestation
What is the incidence of PROM at term?
8% (2-3% before 37 weeks)
What are 5 factors that may contribute to the aetiology of PROM at term?
- Unknown
- Clinical or subclinical infection
- Polyhydramnios
- Multiple pregnancy
- Malpresentations
Why is it important to establish a correct diagnosis of PROM at term?
to plan further management, and if unnecessary interventions are undertaken there is a risk of increased maternal and fetal morbidity
What is the typical history of a woman who has had PROM at term?
sudden gush of fluish leaking form the vagina, recurrent dampness, or constant leaking
What should the examination involve for PROM at term?
- no need to carry out speculum examination if history certain and liquor on pad or undergarments
- if history uncertain, speculum exam should be offered: should see liquor pooling in upper vagina or trickling through cervical os
- coughing or straining may help to demonstrate leaking fluid
- note colour of liquor - blood or meconium staining
In addition to a possible speculum examination, what are 5 other aspects of examination in PROM at term?
- Temperature
- Pulse
- BP
- Obstetric examination of abdomen (including lie and presentation)
- CTG
When should digital examination be avoided in PROM at term?
if conservative management planned, as it increases the incidence of chorioamnionitis, post-partum endometritis, and neonatal infection
What should any concern regarding fetal well-being with PROM at term result in?
indication to deliver
What should signs of chorioamnionitis lead to with PROM at term?
should prompt treatment with antibiotics and rapid delivery
What are 6 clinical features of chorioamnionitis?
- Fetal tachycardia
- Maternal tachycardia
- Maternal pyrexia
- Rising leucocyte count
- Rising CRP
- Irritable or tender uterus
What are the 2 possible routes of management of prelabour rupture of membranes?
- Immediate induction
- Expectant management
What proportion of women with PROM at term will labour spontaneously within 24 hours?
60%
What are 2 risks associaed with expectant management of PROM at term?
- Women more likely to develop chorioamnionitis and endometritis if expectant management lasts >24h
- Baby is more likely to be admitted to SCBU (special care baby unit) - no evidence of difference in baby morbidity/mortality if <24hours expectant management
What are 7 pieces of advice to given if a woman has opted for conservative management following PROM at term?
- Record her temperature every 4h (during waking hours)
- Urgently report any change in colour or offensive smell
- Avoid sexual intercourse (showering and bathing is ok)
- Report any reduction in fetal movements
- Deliver in a unit with neonatal services and remain in hospital for >12 hours after delivery to allow close observation of the baby
- Consider induction if not in labour by 24h
- Seek medical advice if any concerns regarding baby’s well-being in the first 5 days of life (esp first 12h)
