PROM and chorioamnionitis

Question 1

what is PROM ?

Answer 1

pre-labour rupture of membranes before 37 weeks but is not yet in established labour

Question 2

what is the etiology associated with PROM ?

Answer 2

1. idiopathic
2. infection - group B strep, trichomonas Vaginalis
3. cervical incompetence
4. polyhydramnios and multifetal pregnancy
5. cigarette smoking

Question 3

what are the complications of pre-labour rupture of membranes ?

Answer 3

preterm labour
infection ( chorioamnionitis)
placental abruption
oligohydraminous

Question 4

what is the causative organism behind chorioamnionitis ?

Answer 4

GBS

Question 5

what is the cause of oligohydraminous in PROM ?

Answer 5

cord compression leading to fetal bradycardia and hypoxia

Question 6

how is a diagnosis of PROM made ?

Answer 6

history of sudden gush of a significant amount of colourless fluid through the vagina

Question 7

how should a diagnosis of chorioamnionitis be made in a woman who has suffered from PROM ?

Answer 7

measure fetal heart rate

Question 8

what is the most appropriate management for P-PROM ?

Answer 8

Ab: erythromycin should be given for 10 days after diagnosis
antenatal steroids should be given on week 24

Question 9

what are the steroids needed for ?

Answer 9

steroids reduce the incidence of intraventricular hemorrhage and the need for mechanical ventilation in P-PROM

Question 10

what is the management if the woman experiencing P-PROM is in established labour ?

Answer 10

IV MgSo4
IV benzyl penicillin
or clindamycin in penicillin allergy

Question 11

when should delivery happen in women going through P-PROM ?

Answer 11

pregnancies complicated by P-PROM after 24 weeks gestation with no contraindications to continue pregnancy should be offered expectant management till 37 weeks

Question 12

what is most likely to happen in term PROM ?

Answer 12

spontaneous labour pains will start within 24 hours

Question 13

what is the best next step in management of a woman who has gone through PROM and labour has not started within the 24 hours ?

Answer 13

augmentation of labour and IV antibiotics

Question 14

what is the most likely mechanism of infection in chorioamnionitis ?

Answer 14

ascending infection

Question 15

what are the signs of chorioamnionitis ?

Answer 15

1. offensive vaginal discharge
2. fever and malaise
3. lower abdominal pain and 4. uterine tenderness
4. fetal tachycardia

Question 16

if in PROM the mother becomes pyrexial what is the next best step in management ?

Answer 16

IV cefuroxime and metronidazole (for wider coverage)