PROM and PPROM

Question 1

Define PROM and PPROM (with references)

Answer 1

PROM is ‘Prelabour rupture of membranes’ and is when membranes rupture atleast one hour before the start of contractions.
PPROM is ‘Preterm Prelabour rupture of membranes’ before 37 weeks gestation (RCOG, 2010)

Question 2

What increases the likelihood of PROM?

Answer 2

Chorioamnionitis
Ill-fitting presenting part
Polyhydraminious

Question 3

Describe the management of PROM in detail `

Answer 3

Look through a woman’s history and identify any risk factors. Identify the location of the placenta. Do a urinalysis and observe any PV loss. Do maternal obs, FH and FM’s,
If there are any risk factors she will be for obstetric-led care and continuous monitoring (NICE, 2014). If there are no risk factors intermittent auscultation will suffice.
There is no need to do a speculum unless there is uncertainty. A VE should only be done when she is in established labour.
Woman should receive expectant management as NICE, 2014 states that 60% of women with go into labour spontaneously before 24 hours. Women should be informed that there is a 1% chance of neonatal infection with PROM.
In 24 hours after PROM, women should look for any signs of infection, observe PV loss and measure temp every 4 hours.
FH and FM’s assessed at initial contact and then at 24 hours.
If labour has not started in 24 hours, IOL would be advised and further monitoring.

Question 4

What is PPROM?

Answer 4

‘preterm prelabour rupture of membranes <37 weeks’

Question 5

What statistics does RCOG (2010) give for PPROM?

Answer 5

It complicates 2% of deliveries and is attributed to 40% of preterm labours. It is associated with high morbidity and mortality.

Question 6

Complications of PPROM:

Answer 6

Prematurity
Sepsis
Pulmonary hypoplasia (incomplete development of the lung)

Question 7

Causes of PPROM:

Answer 7

Trauma
Polyhydramnious
Chorioamnionitis - GBS, E-coli, Chlamydia

Question 8

Management plan for PPROM:

Answer 8

Look at full history and location of placenta from scans. Identify any risk factors. Look at PV loss on pad and do urinalysis. Maternal observations, FM’s and FH.
RCOG (2010) recommends CTG monitoring.
PPROM can be confirmed with speculum or USS
Clinical signs of chorioamnionitis should be observed such as pyrexia, tachycardia, vaginal odour. For this reason, Maternal obs, FH and Fm’s should be assessed ever 4-8 hours (RCOG, 2010).
Prophylactic ABX (erithromicine) should be given following PROM for 10 days or until labour (RCOG, 2010).
Antenatal corticosteroids such as betamethasone or dexamethasone should be given from 24-34 weeks to aid lung development and prevent RDS.
Delivery can be considered after 34 weeks if no other indication to deliver earlier than this.
*NICE (2015) also reccomends giving magnesium sulphate for women in etsablished preterm labour or if it is imminent in 24 hours for neurodevelopment and protection.

Question 9

When, what and why are antenatal corticosteroids given?

Answer 9

Betamethasone or dexamethosone are given between 24 and 34 weeks to aid lung development and reduce the risk of RDS,