PROM Flashcards
What is the incidence of term PROM?
8%
1:12
What is the definition of TERM PROM?
Rupture of membranes prior to the onset of labour at or beyond 37weeks gestation
What % Spontaneous labour follows term PROM
24h
48h
96h
24h - 70%
48h - 85%
96h - 95%
What are the immediate risks of TERM PROM?
Cord prolapse
Cord compression
Placental abruption
What are the criteria for expectant management for TERM PROM?S
Fixed cephalic presentation GBS negative No evidence of infection Normal CTG No VE, cervical change Commitment to 4 hourly matenral temp, evaluation of vaginal loss and assessment of fetal wellbeing
What is the method of choice for active management of TERM PROM?
Oxytocin
PGs may have a role in women with an unfavourable cervix
What are the delayed risks of TERM PROM?
Maternal infection
Neonatal infection: death, chronic lung disease, cerebral palsy
Role of the initial assessment of women with TERM PROM?
Confirm
- diagnosis (sterile speculum, no VE, can use amnisure)
- gestation
- presentation
Assess maternal and fetal wellbeing
Cause of false positive rates for amnisure?
blood or semen, alkaline antiseptics, certain lubricants, trichomonas, bacterial vaginosis
False positive rate for amnisure?
19-30%
Cause of false negative rates for amnisure?
prolonged membrane rupture and minimal residual fluid
When should amnisure be used?
When there is uncertainty re diagnosis. It shouldn’t be part of routine assessment.
Summary meta analysis of PROM management:
Outcomes?
- Maternal chorioamnionitis
- definite or probable early-onset neonatal sepsis
- caesarean section rate
- Neonate receiving antibiotics
- Neonatal admission to a neonatal special care
or intensive care unit
Summary meta analysis of PROM management:
Rates maternal chorioamnionitis?
Planned birth: 54/1000
Expectant management: 110/1000
RR 00.49
Summary meta analysis of PROM management:
definite or probable early-onset neonatal sepsis
Planned birth: 30/1000
Expectant management: 41/1000
RR 0.73
Summary meta analysis of PROM management:
caesarean section rate
Planned birth: 126/1000
Expectant management: 150/1000
RR 0.84 but not statistically significant as CI crosses 1
Summary meta analysis of PROM management:
Neonate receiving antibiotics
Planned birth: 85/1000
Expectant management: 126/1000
RR 0.61
Summary meta analysis of PROM management:
Neonatal admission to a neonatal special care
or intensive care unit
Planned birth: 129/1000
Expectant management: 160/1000
RR 0.75
Reported birth experiences?
Women in the planned early birth group had more positive experiences compared with women in the
expectant management group
Women with GBS?
Should be expectantly managed as soon as possible and covered with IV ABx
Timing of management with PROM?
Recommend delivery within 24 hours
Criteria for expectant management for women who choose it?
- Fixed cephalic presentation.
- Negative Group B streptococcus (GBS) status and no prior history of a baby with EOGBS infection.
- No signs of infection (maternal tachycardia, fever, uterine tenderness).
- Normal CTG and fetal movements.
- Clear amniotic fluid
- Adequate resource/staffing to provide support as an outpatient or inpatient.
- Commitment to regular assessment of maternal temperature, vaginal loss and fetal movements. (4-
hourly temperature check during waking hours is recommended). - Access to reliable transport.
- Clearly documented plan for review
What is the role of antibiotics in term PROM?
a) Women known to be GBS negative
Meta-analysis does not show any benefit for women or neonates from routine antibiotic administration prior to labour in women with ruptured membranes in whom timely induction of labour is planned.
b) Women in whom GBS status is unknown.
Antibiotic prophylaxis should be used in line with guidance from RANZCOG guideline, “Maternal
Group B Streptococcus in pregnancy: screening and management”.
c) Chorioamnionitis
If chorioamnionitis is diagnosed or suspected, delivery should be expedited and broad spectrum
antibiotics should be administered
Should induction of labour be undertaken with oxytocin or prostaglandins?
Induction of labour with oxytocin is the usual method in Australia but oxytocin or oral prostaglandins are used in New Zealand. Prostaglandins may also be used in women with an unfavourable cervix.
