Preterm prelabour rupture of the membranes

Question 1

PPROM

Answer 1

Membranes rupture before labour <37w

Question 2

Risk factors

Answer 2

Smoking
Previous preterm delivery
Vaginal bleeding
Lower genital tract infection
About 1/3 women with PPROM have a positive amniotic fluid culture

Question 3

Clinical features

Answer 3

‘popping sensation’ or ‘gush’ followed by leaking

Pool of fluid in posterior fornix on speculum diagnostic

Question 4

Investigations

Answer 4

Digital exam best avoided but performed to exclude cord prolapse if presentation not cephalic
US may show reduced liquor
High vaginal swab for infection, also FBC and CRP
CTG for fetal wellbeing

Question 5

Management

Answer 5

Balance between risk of preterm delivery and risk of infection
Admission and steroids
Close maternal and fetal monitoring
Induction at 36w
Prophylactic erythromycin
If evidence of infection, give IV antibiotics and deliver the fetus

Question 6

Complications

Answer 6

Preterm delivery
Chorioamnionitis, infection of fetus, funisitis (cord infection)
Umbilical cord prolapse
Absence of liquor => pulmonary hypoplasia and postural deformities

Question 7

Chorioamnionitis symptoms

Answer 7

Contractions
Abdo pain
Fever
Tachycardia
Uterine tenderness
Coloured or offensive liqour