PRemature rupture of membranes

Question 1

What is PROM and PPROM

Answer 1

PORM- term-prelabour rupture of membrane
Spontaneous rupture before 37w
occurs in 10% of women -phsyiological

PPROM- PRE_-TERM (24-36+6)
Spontaneous rupture of emembrane before labour
caused by weakened membraned- subclinical
2% of preg

Question 2

sx of PROM and PPROM

Answer 2

Sudden gush of fluid from vagina
PV- constant trickle

contractions (regular and painful)
Exam -infectons signs

Question 3

Ix of PROM and PPROM

Answer 3

dont do bimanual-risk of infection
DONT DO TESTS if LABOUR IS ESTABLISHED

1st speculum-
OS- open or closed
Pooling of amnionic fluid is diagnostic-
(dont use gelly- complicate results
Only do if ROM not evedent

If 30w>, contraction and OS closed- TVUSS for cervical length
<15mm- likely PPROM
>15mm-unlikely PPROM

2nd- IGFBP/PAMG
(insulin GF binding protein/ Placental alpha microglobulin) - very sensitve in neg unlikely PPROM

3rd- foetal fibronectine/FFN –may be present

Question 4

RF of PPROM/PROM

Answer 4

Previous PROM
APH, Trauma, UTI
Smoking, multiple preg
Polyhydramnios
Uterine abnormalities, cervical incompetance

Question 5

Mx of PPROM

Answer 5

admission + expectant Mx until 37w if can

Meeication-
NO TOCOLYSIS
Erythromycin <37w, 24h, for 10 days
steroids <34w (care with diabetes)
MgSO4- <30w

Monitor for chorioamnionitis
clinical, bloods, CTG

complicaitons- maternal sepsis, cord abruption
foetal- chorioamniotis, cord prolapse, PTL,

Question 6

Mx of PROM

Answer 6

Depends of gross amniotic fluid examined on speculum–

CLear-
0-24h- expectant managemement
>24h- IOL
4h temperature and 24hr foetal minotor
augment with prostaglandins, oxytocin

Meconium- immediate labour ASAP