Term PROM Flashcards

1
Q

Define PROM at term.

A

Confirmed rupture of membranes prior to the onset of labour, at ≥37 weeks gestation

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2
Q

What is the incidence of PROM.

A

8%

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3
Q

What is the management of term PROM?

A
  • Clinical Hx /exam / obs / bloods - check for signs of chorioamnionitis
  • CTG
  • Confirm gestation
  • Confirm presentation
  • Vaginal swab for GBS carriage
  • Induction WITHIN 24 hours with syntocin (consider PGE if unfavourable)
  • Continuous CTG in labour
  • No need for routine antibiotics, if PROM <24hours
  • If GBS - needs immediate IOL and GBS antibiotic prophylaxis
  • If meconium / suspected chorioamnionitis for immediate IOL
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4
Q

What is the evidence for expectant versus early (<24hours) induction?

A

Cochrane 2017

Planned early induction <24 hours is associated with:

  • reduction in maternal chorioamnionitis and endometritis (roughly 50%; RR 0.49); Absolute risk: 11–>6%
  • Reduction in suspected and confirmed neonatal sepsis (roughly 25%, RR 0.73)
  • Reduced neonatal antibiotic use, admission to SCBU/NICU, hospital stay
  • No increase in caesarean section
  • Improved maternal satisfaction
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5
Q

Compare Amnisure and Actim PROM for PROM detection.

A
  • Amnisure 100% sensitive and specific
  • Actim PROM marginally less
  • Both POC tests, with quick results (<10mins)
  • Both are not affected by semen and trace blood
  • Can have false positives 15-30% in threatened preterm labour
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6
Q

Compare Amnisure and Actim PROM for PROM detection.

A
  • Amnisure 100% sensitive and specific in RCT
  • Actim PROM marginally less
  • Both POC tests, with quick results (<10mins)
  • Can have false positives 15-30% in threatened preterm labour
  • false-positive test results may occur in the presence of blood or semen, alkaline antiseptics, certain lubricants, trichomonas, or bacterial vaginosis.
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7
Q

What are the early and late risks of PROM?

A

early

  • Cord prolapse
  • Cord compression
  • abruption

Late

  • Neonatal infection –> chronic lung disease, cerebral palsy, death
  • Chorioamnionitis and/or maternal sepsis
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8
Q

What are the early and late risks of PROM?

A

early

  • Cord prolapse
  • Cord compression
  • abruption

Late

  • Neonatal infection –> chronic lung disease, cerebral palsy, death
  • Chorioamnionitis and/or maternal sepsis
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9
Q

Is there any evidence to guide induction method?

A

Cochrane 2017

  • Subgroup analyses
  • Syntocin and SL misoprostol were associated with lower rates of infection
  • Lower rates of caesarean section using SL misoprostol
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10
Q

What are risks/causes for PROM?

A
  • Over distension of the uterus (e.g. polyhydramnios, multiple pregnancy)
  • Disruption in membranes function
  • Infection
  • Smoking
  • Frequent digital examinations
  • Coitus
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11
Q

TERMPROM trial findings.

A

Multicentre randomised control trial (1996)
Rationale: >60% women labour within 24hours, 95% women labour within 72 hours, IOL assumed to lead to increased CS rate

Inclusion: Prelabour rupture of membranes, >37wks, cephalic, no contraindication to vaginal birth
Randomised to:
IOL oxytocin vs expectant, then IOL after 4 days
IOL PGE vs expectant, then IOL PGE after 4 days

1st outcome: neonatal infection
2nd outcome: CS delivery

  • IOL group had significant reduction in:
    clinical chorioamnionitis, need for ABx in labour, or postpartum fever >38
  • No significant effect on neonatal infection
  • no significant difference on CS rate
  • IOL with oxytocin had fewer VE, went into active labour sooner, had shorter labours and shorter time from PROM to delivery than in the PGE or expectant management groups
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12
Q

Women declining induction, what criteria are required for conservative management?

A

• Fixed cephalic presentation.
• Negative Group B streptococcus (GBS) status and no prior history of a baby with EOGBS infection.
• No signs of infection (maternal tachycardia, fever, uterine tenderness).
• Normal CTG and fetal movements.
• Clear amniotic fluid
• Adequate resource/staffing to provide support as an outpatient or inpatient.
• Commitment to regular assessment of maternal temperature, vaginal loss and fetal movements. (4-
hourly temperature check during waking hours is recommended).
• Access to reliable transport.
• Clearly documented plan for review

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13
Q

What percentage of women will labour at 24hrs? 48hrs? 96 hrs?

A
24 = 70%
48 = 85%
96 = 95%
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