PROM and PPROM

Question 1

Define PROM

Answer 1

Leakage of amniotic fluid in the absence of uterine activity

Question 2

What causes PROM?

Answer 2

Anything that weakens the membranes
- Infection (UTI, PID)
- Smoking
- Twins
- Polyhydramnios
- Malpresentation

Question 3

How is PROM investigated?

Answer 3

1. Examine (obstetrics, speculum)
2. Amnisure
3. Bloods (FBC, CRP, group and hold)
4. Ultrasound
5. CTG

Question 4

How is term PROM managed?

Answer 4

Expectant management vs induction of labour

Question 5

Define PPROM

Answer 5

Pre-labour rupture of membranes before 37 weeks

Question 6

List 5 risk factors for PPROM

Answer 6

1. Mother - African, smoker, low socioeconomic class
2. Current obs - APH, polyhydramnios, twins
3. Past obs - history of PPROM, PTL
4. Gynae - STI/PID

Question 7

List 5 differentials for PPROM

Answer 7

1. Urinary incontinence
2. Vaginal discharge
3. Mucous plug
4. UTI
5. APH

Question 8

How is PPROM investigated?

Answer 8

1. Exam (IMEWS, Leopold’s, speculum)
2. Amnisure
3. High vaginal swab (if <37w)
4. Bloods
5. Ultrasound
6. CTG

Question 9

How is PPROM managed if delivery is iminent?

Answer 9

Inform the neonatal team
Benzylpenicillin for GBS
Discuss plan for delivery
Tocolysis only if transfer is needed

Question 10

How is PPROM managed if delivery is not iminent?

Answer 10

Admit, observe and monitor
Regular CTG, bloods and ultrasound
IV fluids and analgesia
Vaginal swab
Antibiotic prophylaxis
Plan for delivery (ideally 36-37w)

Question 11

What antibiotic prophylaxis is used in PPROM? Why is augmentin contraindicated?

Answer 11

GBS - benzylpenicillin
Chorioamnionitis - erythromycin

Increased risk of necrotising enterocolitis with augmentin

Question 12

List 5 complications of PPROM.

Answer 12

1. Prematurity (RDS, sepsis, neonatal death)
2. Chorioamnionitis
3. Cord prolapse
4. IVH
5. PPH