Premature Membrane Rupture

Question 1

What are the 2 main classifications of premature membrane rupture?

Answer 1

Premature rupture of membranes (PROM) / prelabour rupture of membranes at term

Pre-term prelabour rupture of membranes (P-PROM)

Question 2

Define PROM

Answer 2

The rupture of membranes at least 1 hour PRIOR to the onset of labour at more than or equal to 37 gestation

Question 3

Define preterm prelabour rupture of membranes

Answer 3

The rupture of membranes occurring at less than 37 weeks gestation

Question 4

PROM occurs in what percentage of term pregnancies?

Answer 4

10-15%

Question 5

P-PROM complicates what percentage of pregnancies?

Answer 5

2% and has higher rates of maternal and fetal complications

Question 6

P-PROM is associated with what percentage of preterm deliveries?

Answer 6

40%

Question 7

What causes PROM?

Answer 7

Mostly unknown 
Infection of lower genital tract or amnion 
Polyhydraminos 
Multiple pregnancy 
Malpresentation

Question 8

When there is PROM the risk of serious infection is increased…

Answer 8

1% versus 0.5% for women with intact membranes

Question 9

Do most women after PROM go into spontaneous labour within 24 hours?

Answer 9

Yes (60%)

Question 10

What is more likely to happen 24 hours after PROM (with no spontaneous labour)?

Answer 10

Chorioamnionitis and endometritis more common

Baby more likely to be admitted to SCBU

Question 11

How should PROM be managed?

Answer 11

Conservative management is appropriate up to 24 hours post membrane rupture if the liquor is clear, mother well and no fetal concerns
She should regularly check temperature and report to labour ward if any changes e.g in fetal movements, colour/smell of liquor, avoid sexual intercourse

Question 12

If spontaneous labour has not happened 24 hours after PROM, what should be done?

Answer 12

NICE recommends induction of labour
Vaginal prostaglandins = preferred method
Gel 1-2mg for 6 hours followed by oxytocin infusion if contractions not started

Question 13

In cases of PROM, women giving birth 24 hours after rupture should give birth where?

Answer 13

Where there are neonatal care facilities

Advised to stay in hospital 12 hours after birth

Question 14

In cases of PROM, is routine prophylactic IV antibiotics recommended during labour?

Answer 14

No
IV antibiotics should be commenced if there is clinical evidence of infection - broad spectrum, should cover for GBS
Take HVS, send MSU and blood cultures before starting antibiotics

Question 15

In cases of PROM, what indications are there for immediate induction of labour?

Answer 15

GBS carriers, HIV carriers, signs of chorioamnionitis, concerns about fetal movement, meconium stained liquor, herpes simplex genital infection