PROM Flashcards
causes of spontaneous ROM
following an invasive procedure eg. amniocentesis or fetoscopy
infection
multiple pregnancies
antepartum haemorrhage
cervical incompetence
expectant management is appropriate for
women who are GBS negative or GBS unknown and have no signs of infection or other complications
what kind of IOL do you use for PROM
oxytocin rather than prostaglands, as this s associated with an increased risk of chorioamnionitis and neonatal infection
management principles for GBS positive women
should be commenced on IV Abs immediately and have an IOL within 6 hours of the rupture of memebranes
for women with PROM with signs of infection
immediate IOL
advice for GBS negative or unknown women who elect for expectant management
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
should you do a digital vaginal examination
avoid this unless immediate induction is planned or cord prolapse is suspected
if a woman has PROM with cervical suture in place
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
criteria for expectannt management
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)
after 18 hours post ROM
commence IV antibiotics
IOL should be commenced once the membranes have been ruptured for 24 hours
at 24 hours post ROM
if not in labour, transfer to hospital for IOL
antibiotic prophylaxis
for GBS positive women
or for GBS neg/unknown women whose ROM>18 hours
use Ben Pen IV
PPROM
ROM <37 weeks
risk factors for PPROM
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
spec exminnation when there is a PROM
must be sterile due to increased risk of chorioamnionitis
what might you see on vaginal examination of PROM/PPROM
pool of fluid in the posterior fornix
note colour, amount, smell
take swabs and use amnicator to confirm ROM
which swabs to take for PROM
LVS for culture
rectal swab for GBS
ECS for C&G
HVS if there is purulent discharge
investigations for PROM
bedside: CTG, urinalysis, vaginal swabs nd MC&S and STI screening
labs: MSU, CRP, ESR, UECs, FBC, Group and antibody
imaging: ultrasound (transabdominal, transvaginal)
management for PPROM
expectant management is best if below 30 weeks, consider delivery at 34 weeks
give betamethasone
use of tocolysis
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.
outpatient management for previable PROM
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
antibiotics for PPROM
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
can you use vaginal prostaglandins during IOL for PROm
no, associated with an increased risk ofchorioamnionitis
us oxytocin instead
