Premature rupture of membranes (PROM)

Question 1

Define PROM.

Answer 1

Spontanous rupture of membranes prior to the onset of labour at term.

Question 2

What is the aetiology of PROM?

Answer 2

Natural physiological mechanism including Braxton Hicks contractions and cervical ripening lead to weakening of the membranes.

Question 3

What are the risk factors for PROM?

Answer 3

Prior preterm birth

Cigarette smoking

Polyhydramnios

Urinary and sexually transmitted infection

Prior PROM

Low BMI

Question 4

Summarise the epidemiology of PROM.

Answer 4

8% of pregnancies

Question 5

What are signs and symptoms of PROM?

Answer 5

Sudden gush of fluid PV, followed by constant trickle

General: Assess signs of infection (fever, tachy)

Vaginal: Avoid if possible to reduce risk of infection.

Speculum if Hx uncertain – confirm pooling of liquor in vagina, not colour.

Question 6

What investigations should be performed for PROM?

Answer 6

Consider microbiology

High vaginal swab/low vaginal swab

Question 7

What is the management for PROM?

Answer 7

Clear liquor and no known GBS:

Expectant management for 24h, most will labour. Offer augmentation of labour after 24h, definitely induce after 72h (with Pglandins and oxytocin infusion).

·Abx cover - benzylpenicillin or penicillin if allergic

4 hourly temperature and 24h fetal cardiac monitoring.

Meconium or known GBS/pyrexia: Augment labour immediately (antibiotic if pyrexic or GBS+)

Postnatal: Observe neonate for 12h minimum.

Question 8

What are complications associated with PROM? What is the prognosis for PROM?

Answer 8

Increased risk of ascending infection.

60% labour within 24h.