Prelabour rupture of the membranes Flashcards
Definitions
- Premature rupture of membranes (PROM) – rupture of the amniotic sac later than ≥37 weeksand at least 4 hours before labor begins.
- Preterm premature rupture of membranes (PPROM) – PROM but occurring between weeks 24-37.
Risk factors PROM
- Infections
- Uterine distension (polyhydramnios, multiple pregnancies)
- Iatrogenic intervention (amniocentesis)
- Uterine contractions
Diagnosis PROM
- Digital vaginal examination less recommended due to reduce of chorioamnionitis.
- Physical examination with signs of:
a. Prominence palpitation of fetus
b. Reduced size of uterus
c. Presence of meconiumd. Continuous leakage
- Speculum examination and assess cervical dilatation
- Usage of nitrazine sticks (pH sensitive) – turn blue (not widely used due to their cost)
- Ultrasound examination to assess AFI and presence or absence of amniotic fluid in the vagina
- If there is fluid a swab is used to for culturing the fluid.
Management PROM
- Preventiona.
Vaginal or intramuscular progesterone (30% efficacy)
- Treatment
a. Depends on several factors, including gestational age and the presence or absence of chorioamnionitis.
b. Most women with PROM deliver spontaneously after 48 hours.
Management Infection
In case of positive culturingincluding increased maternal CRP, leukocytosis, fever and tachycardia – induction of labor is suggested with use an appropriate antibiotic –regardless of gestational age.
In case of negative culturing –use broad-spectrum antibiotic.
Tocolysis are ineffective in PROM in case labor is well established and infection should be considered. If above >28 weeks delivery is recommended
Management PROM
Above ≥37 weeks induction oflabor (prostaglandins or syntocinon
Management PPROM
> 34 weeks managed the same “at term”.
<34 weeks antibiotics (suspect infection as etiology) and steroids until week 34 is reached, then deliver.
