Preterm premature rupture of membranes

Question 1

What is the difference between PROM and PPROM?

Answer 1

PROM - premature rupture of membranes: >37w gestation presenting w ROM prior to onset of labour
PPROM - preterm premature rupture of membranes: ROM <37w before onset of labour

Question 2

What are causes of PROM

Answer 2

Mostly unknown

Question 3

When is conservative management appropriate?

Answer 3

up to 24hr post membrane rupture if the liquor is clear, mum well and no fatal concerns

Question 4

When should IOL occur

Answer 4

if spontaneous labour hasn’t commenced by 24hr

Question 5

What is given for IOL

Answer 5

Vaginal prostaglandin E2 gel for 6 hr followed by an oxytocin infusion if contractions haven’t started

Question 6

When are prophylactic abx indicated

Answer 6

if clinical evidence of infection

Question 7

what infection must be covered if prophylactic abx is used

Answer 7

GBS

Question 8

What are indications for immediate IOL?

Answer 8

GBS carriers 
HIV carriers 
signs of chorioamnionitis
concerns of fetal movements 
meconium stained liquor 
herpes simplex inf.

Question 9

What is a risk to the neonate of PROM

Answer 9

INFECTION so monitor observations

Question 10

What are the complications of PPROM

Answer 10

prematurity
infection
pulmonary hyperplasia
chorioamnionitis (mum)

Question 11

Why should digital examination be avoided in PPROM

Answer 11

Risk of infection

Question 12

What is the management of PPROM

Answer 12

Admit
look out for chorioamnionitis
oral erythromycin (10days)
corticosteroids (ARDS)
consider deliver at 34 weeks