PROM and Preterm Labour

Question 1

Define PROM and PPROM.

Answer 1

Premature rupture of membranes (PROM) is defined as rupture of membranes occurring before the onset of labor
at term (≥ 37 weeks) or earlier (preterm PROM if < 37 weeks

Question 2

Describe how the pathophysiology of PROM and PPROM comes about?

Question 3

What are the risk factors of PROM/PPROM? And explain how they come to be?

Answer 3

Previous PROM or PPROM
Ascending infection (UTI)
Nutrition deficiencies
Smoking
Multiple gestation
Polyhydramnios
Incompetent cervix
Antepartum bleeding ( mostly 2nd and 3rd trimester)
Genetic predisposition

Question 4

Describe the clinical presentation of someone presenting iwth PROM/PPROM.

Answer 4

A sudden ‘gush of fluid’ leaking from the vagina
Cramping
Recurrent dampness or constant leaking
No Contractions
Back pain

Question 5

What are the imminent history taking points in someone with PROM?

Answer 5

Contractions
Fetal movement
Time of possiblerupture
Amount of fluid
Color and odor of fluid
Vaginal bleeding
Pain
Recent sexual encounters
Recent trauma and recent physical activity

Question 6

What exam done in a patient with PROM/PRROM?

Answer 6

A sterile speculum exam

Question 7

What investigations are done in PPROM?

Answer 7

Ultrasonography
Full blood count
Urinalysis, culture and sensitivity
Nitrazine test or PH indicator
Fern test

Question 8

What is the normal vaginal pH and what is the pH of liqour?

Answer 8

Vagina: 4.5-5.5
Liqour: 7-7.75

Question 9

What exam should be avoided and why?

Answer 9

Digital vaginal examination

Because it can introduce organisms into cervical canal, increases the incidence of chorioamnionitis, post-partum endometritis and neonatal infection.

Question 10

What is seen in a sterile speculum exam in P/PROM?

Answer 10

To Visualize amniotic fluid passing from the cervical canal and pooling in the vagina.
To exclude any signs of cervicitis, umbilical cord prolapse, vaginal bleeding or fetal prolapse
To take cervical swab

Question 11

Why is temperature, BPs and Pulse rate important?

Answer 11

To rule out chorioamnionitis characterised by maternal fever and tachycardia

Question 12

Describe the management of P/PROM

Answer 12

REFER TO GUIDELINES

Question 13

What are the fetal complications of PROM/PPROM?

Answer 13

Preterm
Placenta Abruption
Neonatal Sepsis
Cerebral Palsy
Infection
RDS

Question 14

What are the maternal complications of P/PROM?

Answer 14

Infection
Risk of C/S
Thromboembolic events

Question 16

What is Preterm Labour?

Answer 16

Preterm labor means derivery that occur early I.e. before 37 completed weeks of gestation.

Question 17

What are the causes of preterm labour?

Answer 17

Ascending infection
UTI
Cervicitis
Bacterial vaginosis
Candida infection
Systemic infection
Febrile illness i.e malaria
Uterine distension
Multiple pregnancy
Macrosomia
Polyhydramnios

Placenta abruption
PPROM
Uterine malformations
Bicornuate uterus
Fibroid uterus
Cervical weakness

Question 18

What are the risk factors of preterm labour?

Answer 18

Age < 18
Previous preterm birth
Previous still birth
High parity
Anemia
Low social economic status
Hypertension in pregnancy
Diabetes
Maternal stress
Persistent malaria

Question 19

What is the clinical presentation of a patient in preterm labour?

Answer 19

Lower abdominal pain
Backache
Early contractions

Question 20

What exam can be done in Preterm Labor and when can it be done?

Answer 20

Vaginal Exam to confirm cervical effacement and dilation but after placenta abruption and previa have been ruled out.

Question 21

What investigations are done in Preterm labour?

Answer 21

Transvaginal ultrasound for short cervical length
Sterile Speculum exam
High vaginal swab
Urinalysis
MRDT
FBC

Question 22

Describe the management of Preterm Labor?

Answer 22

REFER TO GUIDELINES.