PROM

Question 1

What defines preterm PROM?

Answer 1

PROM that occurs before 37 weeks

*associated with ~30% of deliveries

Question 2

PROM leading to preterm delivery is associated with what 5 neonatal complications of maturity

Answer 2

1. RDS
2. Intraventricular hemmorrhage
3. Neotal infection/ sepsis
4. NEC
5. neurologic and neuromuscular dysfunction

Question 3

What are 3 major maternal complication of PROM?

Answer 3

1. intrauterine infection
2. abruptio placentae
3. prolapsed umbilical cord

Question 4

What two infections increase risk of intrauterine infection?

Answer 4

1. BV

2. Gonnorhea

Question 5

At less than 22 weeks, what are some specific risks to the fetus (as a result of what process)

Answer 5

Persistent oligohydramnios at before 22 weeks–> incomplete alveolar development and pulmonary hypoplasia

Question 6

What are 7 risk factors for PROM?

Answer 6

1. Smoking (2x)
2. Prior PROM (2x)
3. Short cervical length (under 25 mm)
4. Prior preterm delivery
5. Hydramnios
6. multiple gestations
7. threatened abortion (bleeding early in pregnancy)

Question 7

Why is it thought infection might cause PROM?

Answer 7

Metabolites from bacteria and the inflammatory response weaken the fetal membranes and may increase prostaglandin synthesis to cause contractions

Question 8

Approximately half of Pts with PPROM will undergo labor in how long?

Answer 8

48 hours.

90% in 1 week

Question 9

What are four clinical indicators of chorioamnionitis?

Answer 9

1. Maternal fever
2. Maternal tachycardia
3. Uterine tenderness
4. Malodorous vaginal discharge

Question 10

What is an early indicator of possible chorio?

Answer 10

Fetal tachycardia

Question 11

What are 4 tests for PROM?

Answer 11

1. Speculum exam showing pooling of amniotic fluid in posterior fornix
2. Positive nitrating test ( showing basic fluid)
3. Ferning pattern on microscope
4. U/S showing oligohydramnios

Question 12

What Abx are used if chorio is suspected?

Answer 12

IV ampicillin and gentamicin

Question 13

At what gestational age are steroids no longer needed for baby?

Answer 13

After 32 weeks

• infection is also a contraindication for steroid use

Question 14

What test can be diagnostic of chorioamnionitis?

Answer 14

Amniocentesis revealing organisms on gram stain

Question 15

What two classes of organisms are most commonly implicated in chorio?

Answer 15

1. Group B strep

2. Gram negative enterics (E. Coli)

Question 16

What organism may cause chorio without rupture of membranes preceeding it?

Answer 16

Listeria - look for history of eating unpasteurized milk products

Question 17

What is the most common fetal abnormal finding in PPROM A?

Answer 17

Variable decelerations –> due to cord compression from oligohydramnios

Question 18

What are the general management goals of PPROM?

Answer 18

Screen for chorioamnionitis and placental abruption
If neither is present, prolong the latency period depending on gestational age
*pts must be on impatient obs until membranes reseal or delivery

Question 19

Before 34 weeks and no amnionitis, what is next step in management

Answer 19

Latency antibiotics –> ampicillin and erythromycin IV for 48 hours then oral amoxicillin and erythromycin

Question 20

At under 32 weeks what is management

Answer 20

Latency abx and steroids

Question 21

at 32-34 weeks what is management?

Answer 21

consider delivery if documented fetal lung maturity

Question 22

at over 34 weeks what is management?

Answer 22

augment labor for delivery or C/S depending on fetal/maternal indications

Question 23

What 3 things warrant prompt delivery?

Answer 23

1. Rupture over 34 weeks
2. Chorioamnionitis
3. NRFHT