Preterm premature rupture of membranes

Question 1

PPROM - epi

Answer 1

1/3 of preterm deliveries. 1/3 of PPROM have overt infection

Question 2

PPROM chorioamnionitis - background

Answer 2

May cause few symptoms but associated with significant neonatal morbidity and mortality. Also associated with significant risks to the mother

Question 3

PPROM chorioamnionitis - hx

Answer 3

1. Vaginal loss - gush, constant trickle or dampness (ROM)
2. Fever
3. Malaise
4. Abdominal pain, including contractions
5. Purulent/offensive vaginal discharge

Question 4

PPROM chorioamnionitis - ex

Answer 4

1. Maternal pyrexia
2. Maternal tachycardia
3. Uterine tenderness
4. Fetal tachycardia
5. Speculum - offensive vaginal discharge (yellow/brown). NO VE bc increased risk of infection

Question 5

PPROM chorioamnionitis - ix

Answer 5

1. FBE
2. CRP (raised -> indicates infection)
3. Swabs (high vaginal swab, low vaginal swab)
4. MSU
5. U/S for fetal presentation, EFW and liquor volume

Question 6

PPROM - mx

Answer 6

Mx - if chorioamnionitis (3)

1. Steroids (betametasone IM)
2. Deliver whatever the gestation
3. Broad spectrum abx cover (?)

Mx - if no chorioamnionitis (3)

1. Admit. Inform SCN, liaise with neonatologists
2. Steroids (betametasone IM, 2 doses 24h apart)
3. Abx (erythromycin)

Question 7

PPROM - risks

Answer 7

1. Prematurity
2. Infection
3. Cord prolapse, abruption
4. Pulmonary hypoplasia
5. Limb contractures