Premature Rupture of Membranes at Term Flashcards
What is PROM
Leakage of Amniotic Fluid in absence of Uterine Activity, after 37/40
• 8% of Term Pregnancies; Idiopathic, Clinical/Subclinical Infection, Polyhydramnios, Multiple
Pregnancies or Malpresentation
Presentation of PROM
Typically, history of sudden gush of fluid leaking from vagina, recurrent dampness or constant leaking of fluid; Speculum examination if uncertain history
o Valsalva can demonstrate leaking fluid – Note if Blood or Meconium stained
Avoid Digital Examination if conservative management planned – Increased risk of
Chorioamnionitis, Endometritis and Neonatal Infection
Presentation of Chorioamnionitis
presents as Foetal or Maternal Tachycardia, Pyrexia, Rising Inflammatory Markers, Irritable or Tender Uterus
o Requires prompt treatment with Antibiotics and Rapid delivery of Foetus
Management of PROM
60% will go into labour within 24hrs; 1% risk of serious neonatal infections (2-fold); If Expectant management, more likely to develop Chorioamnionitis and Endometritis if >24h;
More likely for SCBU admission but no evidence for difference in Neonatal outcome if <24h
Expectant Management
Record temperatures, urgently report any change in colour/smell,
Report decreased foetal movements, Delivery in Neonatal unit, Consider induction if >24h;
Use of prophylactic antibiotics controversial
Known Group B Strep Carrier
Immediate Induction encouraged; Mother offered
Benzylpenicillin in labour; Neonates screened soon after birth