PRROM Flashcards
PPROM definition
breakage of the amniotic sac before the onset of labor
PPROM increases risk of
- Chorioamnionitis
Chorioamnionitis
Inflammation of the amnion and chorion due to bacterial infection
- caused by bacteria ascending from gaina into uterus
Symptom of PPROM
- Gush
2. Constant trick;le or dampness
Symptoms of chorioamnionitis
- Fever + Malaise
- Abdominal pain
- Purulent/offensive discharge
Examination of chorioamnionitis
- Maternal pyrexia and tachycardia
- Uterine tenderness
- Fetal tachycardia
Speculum in Chorioamnionitis shows;
Offensive vaginal discharge - yellow/brown
Ix of PPROM
- FBC and CRP - raised WCC and CRP indicate infection
- Swabs of vagina
- MSY
What examination must you not do in suspected chorioamnionitis
VAGINAL EXAM AS THIS INCREASES THE RISK OF INTRODUCING INFECTION
Management of PPROM depends on;
If caused by chorioamnioitis or not
PPROM caused by infection
- Steroids
- Deliver whatever gestation
- Broad spectrum antibiotic cover
PPROM not caused by infection
- Admit
- Give steroids
- Give antibiotics - erythromycin
Risks to fetus from PPROM
- Prematurity
- Infection
- Pulmonary Hypoplasia
- Limb contractures
What is the principal issue with preterm prelabour rupture of the membrane?
Sepsis of both the mother and the fetus.
How do you manage a patient with preterm prelabour rupture of the membrane?
Check fetal lie and presentation - risk of cord prolapse
Digital examination should not be done - unless there are obvious signs of labour - due to risk of infection introduction
Check for symptoms of clinical chorioamnionitis (fever, rigors, green or brown or foul smelling vaginal loss, tender uterus on palpation)
CTG
Blood tests
Administration of prophylactic erythromycin / treat sepsis
Administration of corticosteroids to improve fetal lung maturity
