PROM and PPROM Flashcards
What is PROM?
Pre-labour Rupture of Membranes (occurs at least 1 hour before the onset of contractions)
What are the associated risk factors for PROM?
- Ill-fitting PP (e.g. OP)
- Polyhydramnios
- Chorioamnionitis
Why is PROM an issue?
- Liquor needed for lung development (acts as surfactant)
- Infection risk if >24 hrs
What is the management for PROM if risk factors are present?
- CTG
- Obstetric referral for care planning (e.g. ?induction)
What is the management for PROM if there are no risk factors?
- Intermittent auscultation
- No speculum needed if clear evidence of ROM
- No VE unless in active labour
- Expectant management
What should happen after 24 hours if labour does not occur spontaneously?
IOL
What should women be advised to do to confirm ROM if it is not obvious?
Go for a walk with a sanitary pad in and encourage coughing
What is GBS?
Group B Streptococcus (normal vaginal flora that comes and goes naturally)
How is GBS diagnosed?
In urine or private GBS test if requested (routine testing not recommended)
What is the management for women who are GBS +ve in this pregnancy?
IAP and active management
What is the management for women who had previous GBS in pregnancy?
Active management
What is expectant management of PROM?
Wait 24 hours for spontaneous labour - if this doesn’t occur, IOL
What is active management of PROM?
Give oral misoprostol to encourage contractions (+ augmentation if necessary)
What is IAP?
Intrapartum Antibiotic Prophylaxis
- Benzylpenicillin
- Clindamycin (if allergic to penicillin)
What is PPROM?
Preterm Pre-labour Rupture of Membranes (<37/40 and before onset of contractions)
What are the possible complications of PPROM?
- Premature birth
- Sepsis
- Cord prolapse
- Malpresentation
- APH
What are the risk factors for PPROM?
- Infection
- Polyhydramnios
- Multiple pregnancy
- Cervical incompetence
- Amniocentesis
- Smoking/drugs
- Abdominal trauma/DV
How is PPROM diagnosed?
- Pool of fluid seen in vagina during speculum examination
- Nitrazine test
- USS for oligohydramnios
- Microscopic examination
Who performs a speculum examination?
Term = midwife Preterm = obstetrician
How is the nitrazine test performed?
- Dipped in the fluid to identify if it is liquor
- Inaccurate as can be affected by presence of semen
What is the microscopic examination looking for?
- Ferning of crystalline pattern of dried amniotic fluid
- Presence of lanugo hair
- Foetal epithelial cells
How should PPROM be managed?
- Corticosteroids (as for preterm labour)
- Anitbiotics
- Timing of delivery considered
What are the RCOG recommendations for timing of delivery?
- Consider from 34/40 onwards
- If expectant management, warn of increased risk of chorioamnionitis but decreased risk of respiratory problems
What antibiotics are used for PPROM?
- Erythromycin for 10/7 or until labour
- Penicillin for 10/7 if unable to tolerate/allergic to Erythromycin
What is an amnioinfusion?
Instilling isotonic liquid into the uterine cavity to improve foetal wellbeing
What is the care provided for inpatients with PPROM?
- 4 hourly temp
- Daily CTG
- Daily CRP and WCC
- MSU and LVS/HVS
- ?discharge after 48 hours
What is the care provided for women at home with PPROM?
- Temp QDS (at home)
- No baths, sexual intercourse or tampons
- Twice weekly hospital review
- Fortnightly USS for growth
- Weekly USS for dopplers
- Information re. symptoms
What are the risk factors for GBS?
- Previous baby with GBS
- GBS +ve on swab
- Prematurity
- PROM
- Intrapartum infection
- Pyrexia
