Short discussion on Premature rupture of membrane Definition, Cause, types, Clinical feature, Management

1. By Intern Dr. Borhan Uddin.

2.  Definition- Spontaneous rupture of the membrane any
time after the age of viability but before the onset of
labor is called premature rupture of membrane.
 Incidence of PROM- 10% of all pregnancy.

3.  Causes of PROM-Exact cause is not known-
Obstetrical cause-
1. Multiple pregnancy.
2. Polyhydramnios
3. Malpresentation and contracted pelvis
Maternal infection-
1. UTI .
2. Lower genital tract infection.
3. Chorioamnionitis.
4. Cervical incompetence.
5. Frequent coitus in last month

4.  Diagnosis of PROM-
a) History.
b) Examination
c) Investigation.

5.  History- Sudden escape of watery discharge per vagina either
in the form of gush or slow leak.
 Examination-If chorioamnionitis is developed then sign of
infection.
1) Fever.
2) Tachycardia.
3) Uterine tenderness.
4) Foul smelling discharge.
 Confirmation of diagnosis- Sterile speculum examination
shows liquor escaping out through the cervix and then
examine the fluid.

6.  How we confirm that it is liquor or other fluid?
 Detection of PH by litmus or nitrazine paper- Normal vaginal
PH is -4.5-5.5.If it is liquor then PH-7-7.5.
 Fern test- Fluid from posterior fornix is placed on a slide and
allowed to dry. Amniotic fluid from a fern like pattern of
crystallization.
 Nitrazine test- a sterile cotton tipped swab should be used to
collect fluid from posterior fornix and apply it to nitrazine
paper. If it is amniotic fluid then the paper turns into blue.

7.  Hydrorrhoea gravidarum.
 Incontinence of urine especially in later month.

8.  Investigations-
 CBC-Neutrophilic leukocytosis in case of chorioamnionitis.
 Urine for R/E.
 High vaginal swab for culture and sensitivity test.
 USG for monitoring the fetal well -being.

9.  To start prophylactic antibiotics-
 Need To asses gestational age.
 Patient not in labor.
 Absence of infection and fetal distress.

10. Pregnancy less than 34 weeks – Expectant
treatment and continue for fetal maturity.
Hospitalization.
Bed rest.
sterile valval pad.
prophylactic antibiotic.
Maternal monitoring- pulse, BP, Temp,
uterine tenderness.
Fetal monitoring- FHR, USG, Biophysical
profile.
Injection- Dexamethasone 12 mg 2 dose
12 hourly ( 2.5 amp) which stimulate
type-2 alveolar cell and release surfactant
which prevent RDS.
Pregnancy more than 34 weeks- Wait for
spontaneous onset of labor for 24-48
hours
•If fails-
•Induction with oxytocin
•caesarean section
Pregnency more than 38 weeks- Wait for
24 hours.
•If fails either induction or caesarean
section.

11.  Maternal-
 preterm labor.
 Infection.
 Increase chance of cord prolapse.
 Prolong labor.
 Fetal –
 High perinatal mortality and morbidity.
 Neonatal infection.