PROM

Question 1

causes of spontaneous ROM

Answer 1

following an invasive procedure eg. amniocentesis or fetoscopy
infection
multiple pregnancies
antepartum haemorrhage
cervical incompetence

Question 2

expectant management is appropriate for

Answer 2

women who are GBS negative or GBS unknown and have no signs of infection or other complications

Question 3

what kind of IOL do you use for PROM

Answer 3

oxytocin rather than prostaglands, as this s associated with an increased risk of chorioamnionitis and neonatal infection

Question 4

management principles for GBS positive women

Answer 4

should be commenced on IV Abs immediately and have an IOL within 6 hours of the rupture of memebranes

Question 5

for women with PROM with signs of infection

Answer 5

immediate IOL

Question 6

advice for GBS negative or unknown women who elect for expectant management

Answer 6

check the temperature every 4 hours and report any raised temperatures
avoid sexual intercourse
report to the treating hospital if she is feeling unwell, has any change in colour or smell of vaginal loss, changes in fetal movements

Question 7

should you do a digital vaginal examination

Answer 7

avoid this unless immediate induction is planned or cord prolapse is suspected

Question 8

if a woman has PROM with cervical suture in place

Answer 8

if cervical suture is present, there is a very high risk of sepsis
the suture should be removed as soon as possible and prompt birth must be considered

Question 9

criteria for expectannt management

Answer 9

GBS negative/unknown
cephalic presentation
clear liquor
no signs of infection (maternal tachycardia, fever, uterine tenderness
no cervical suture
women able to assess her own temperative 4 hourly, vaginal loss, fetal movements
reactive CTG (CTG only required if additional risk factors present)

Question 10

after 18 hours post ROM

Answer 10

commence IV antibiotics
IOL should be commenced once the membranes have been ruptured for 24 hours

Question 11

at 24 hours post ROM

Answer 11

if not in labour, transfer to hospital for IOL

Question 12

antibiotic prophylaxis

Answer 12

for GBS positive women
or for GBS neg/unknown women whose ROM>18 hours
use Ben Pen IV

Question 13

PPROM

Answer 13

ROM <37 weeks

Question 14

risk factors for PPROM

Answer 14

multiple gestation pregnancy
urogenital tract infections
previous PPROM
uterine overdistension
second and third trimester bleeding
low BMI
cervical colonisation or cerclage
pulmonary disese
low socioeconomic status
maternal cigarrete smoking

Question 15

spec exminnation when there is a PROM

Answer 15

must be sterile due to increased risk of chorioamnionitis

Question 16

what might you see on vaginal examination of PROM/PPROM

Answer 16

pool of fluid in the posterior fornix
note colour, amount, smell
take swabs and use amnicator to confirm ROM

Question 17

which swabs to take for PROM

Answer 17

LVS for culture
rectal swab for GBS
ECS for C&G
HVS if there is purulent discharge

Question 18

investigations for PROM

Answer 18

bedside: CTG, urinalysis, vaginal swabs nd MC&S and STI screening
labs: MSU, CRP, ESR, UECs, FBC, Group and antibody
imaging: ultrasound (transabdominal, transvaginal)

Question 19

management for PPROM

Answer 19

expectant management is best if below 30 weeks, consider delivery at 34 weeks
give betamethasone

Question 20

use of tocolysis

Answer 20

use to allow 2x doses of corticosteroids to be delivered, or if requiring emergency transfer to a tertiary facility
does not significantly improve perinatal outcome
does increase risk of choriomnionitis
If gestation is less than 34 weeks and in the absence of infection or
complications and in circumstances when a course of corticosteroids has not
been completed, tocolysis may be considered for threatened premature labour.
The extension of steroid use to 36+6 weeks does not mean that tocolytic therapy
is recommended past 34 weeks.

Question 21

outpatient management for previable PROM

Answer 21

Woman to monitor temperature daily and return if above 37 degrees
* Fortnightly USS
* Weekly antenatal clinic review
* There is no role for weekly CRP/FBC or vaginal swabs 13
* Arrange admission if signs of chorioamnionitis or maternal sepsis
* Woman to return if bleeding, signs of preterm labour, abnormal vaginal
discharge
* Woman should be advised to avoid vaginal intercourse, the use of tampons
and swimming/bathing
* Consider re-admission around 23 weeks for 48-72 hours for observation,
administration of steroids; re-review by neonatology and to allow management
planning for the remainder of the pregnancy

Question 22

antibiotics for PPROM

Answer 22

Broad spectrum antibiotic administration is recommended following PPROM to
prevent infection and prolong the pregnancy in the short term, leading to a
reduction in neonatal and maternal morbidity.
oral erythromycin 250mg four times a day for 10 days

Question 23

can you use vaginal prostaglandins during IOL for PROm

Answer 23

no, associated with an increased risk ofchorioamnionitis
us oxytocin instead