PROM and PPROM

Question 1

What is classed as premature?

Risk factors - list a few

Answer 1

Being born <37 wks

Previous preterm birth
Multiple pregnancies
Cervical surgery (LLETZ or cone biopsy)
Uterine anomalies
Pre-existing medical conditions
PET
IUGR

Question 2

PROM:

What does it stand for?

What is the difference between PROM and PPROM?

Answer 2

Premature rupture of membranes

Preterm premature rupture of membranes (PPROM) (<37wks)

Question 3

PROM:

Why are they admitted for 48 hrs?

What 2 things need to be ruled out? - THINK ABOUT PATHOGENS REACHING AMNIOTIC FLUID

If the above 2 things are present, delivery needs to be done soon. What is done to look for the above 2?

Why is CRP not trusted?

What is given to help foetal lung maturity?
What antibiotic is given to reduce neonatal morbidity?

Answer 3

The highest risk of preterm labour

Chorioamnionitis - prophylactic antibiotics (Erythromycin 250mg)
Sepsis

Temperature
MSU
HVS

It develops late.

Steroids

Erythromycin 500mg PO QDS for 10 days

Question 4

PROM:

Risks to the foetus of PROM?

If labour doesn’t occur within 48 hrs, they are sent home. What should they avoid?

If over 34 wks, what can be done if cephalic?

Answer 4

Prematurity
Infection
Pulmonary hypoplasia
Limb contractures

Intercourse
Swimming
Tampons

Induction of labour - IOL

Question 5

P-PROM:

What should be made sure is on-site for premature PROM?

Answer 5

NICU facilities

PPROM is basically the same as PROM but under 37 wks - management is the same

Question 6

preterm labour with intact membranes:

Mnagement:
Fetal monitoring

3 key options?

Answer 6

Tocolysis with nifedipine - CCB to suppress labour

Maternal corticosteroids - <35 wks (Lungs development + reduce foetal distress) – IM
Betamethasone (2 doses 24 hours apart)

IV magnesium sulfate - < 34 wks (protects brain)