Preterm Pre-Labour Rupture of Membranes

Question 1

PPROM Defintion

Answer 1

Rupture of membranes prior to onset of labour (If in a patient who is at less than 37 weeks of gestation; preterm)

Question 2

PPROM Epidemiology

Answer 2

• PROM in 6-19%
• P-PROM in 2%
• P-PROM associated with 40% of preterm deliveries and can lead to significant mortality

Question 3

PPROM RFs

Answer 3

• Smoking
• PHx
• Vaginal bleeding at any time
• Lower genital tract infection

Question 4

PPROM Presentation

Answer 4

-Popping sensation, gush

Question 5

PPROM Ix

Answer 5

-Do not routinely perform digital vaginal examination as this will increase risk of ascending infection
-Signs of ascending infection are foetal tachycardia, mild increase in maternal temperature
Diagnosis
-Actually seeing amniotic fluid draining, sterile speculum examination
-Testing for insulin like growth factor binding protein 1
-Ultrasound
-Temperature monitoring
at least 12 hourly for ascending infection
-Foetal monitoring

Question 6

PPROM Management

Answer 6

• Refer urgently if P-PROM suspected, or ascending infection suspected
• Erythromycin (250mgs qds 10days)
• Penicillin second line or if Group B strep detected
• Do not use co amoxiclav
• Antenatal steroids if between 24 and 34 weeks
• Consider delivery after 34 weeks
• If PROM not premature, induce within 96 hours

Question 7

PPROM Complications

Answer 7

• Three main causes of neonatal mortality in PPROM are prematurity, sepsis and pulmonary hypoplasia
• Umbilical cord prolapse
• Placental abruption

Question 8

PPROM Prevention

Answer 8

• If PHx of preterm or loss and 16-34 weeks, progesterone or cerclage
• Women with no history, in same stage should be offered intravaginal progesterone
• Women with previous pregnancy or history of cervical trauma should be offered cervical cerclage