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By: Tebabere M. (MSc in clinical midwifery)
6/15/2024
PROM
1
Premature/pre-labor rupture of the membranes
(PROM)
6/15/2024
PROM
2
1
Definition premature rapture of membrane
Types
Risk factors
2
Pathophysiology
Differential diagnosis
3
Diagnosis and management
Complication
Presentation outline
Objectives
6/15/2024
PROM
3
After the completion of this session, you will able to:
Define premature rapture of membrane
Identify the risk factors of premature rapture of membrane
Describe the pathophysiology of premature rapture of membrane
Explain the diagnosis approach of premature rapture of membrane
Identify the how to manage premature rapture of membrane
6/15/2024
PROM
4
Definition:
 Membrane rupture that occurs spontaneously before the onset of labor is described as
premature rupture of the membranes (PROM) regardless of the gestational age at which it
occurs
 Prolonged PROM is rupture of membranes for > 12 hours
Latency period : the interval b/n the rupture of the membranes and the onset of
labor
 The duration varies inversely with the gestational age
Almost 90% of women at term will be in spontaneous labor within 24 hrs
But, at 28 to 34 weeks only 50% will go into labor within 24 hrs and 80% within 1
Premature rupture of the membranes (PROM)
PROM….
6/15/2024
PROM
5
Classification
1. Term PROM: is rupture of membranes at or after 37 completed weeks of gestation
2. Preterm PROM: is rupture of membranes before 37 completed weeks of gestation
Incidence:
 PROM complicates about 8% to 10% of pregnancies.
 Preterm PROM that occurs before 37 weeks’ gestation affects about 1% of deliveries overall,
and it is over twofold more common in blacks
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PROM
6
 Mechanical factors: Multifetal gestation, polyhydramnios, pulmonary diseases, cervical
conization/ LEEP/ cerclage
 Urogenital infections: UTI, cervicitis,group B β-hemolytic Streptococcus (GBS) cervical colonization,
bacterial vaginosis
 Previous history of preterm PROM, preterm labor
 Second and third trimester bleeding (e.g. abruptio placenta)
 Other risk factors: Low socioeconomic status, nutritional deficiencies (copper and ascorbic
acid), low BMI, smoking and connective tissue disorders (e.g., Ehlers-Danlos syndrome)
Risk factors
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PROM
7
Pathophysiology
Fetal membrane anatomy and physiology
The fetus develops within the amniotic sac, which is surrounded like a balloon by
the fetal membranes
The membranes consist of a thin amnion layer that lines the amniotic cavity and a
thicker outer chorion directly apposed to the maternal decidua
The amnion fuses to the chorion near the end of the first trimester of pregnancy,
and these layers are subsequently attached by a collagen-rich connective tissue
Together, the amnion and chorion are stronger than either layer independently
6/15/2024
PROM
8
The pathogenesis of spontaneous membrane rupture is not completely
understood
 The strength and integrity of fetal membranes derive from extracellular
membrane proteins, including collagens, fibronectin, and laminin
Preterm PROM likely results from a variety of factors that ultimately lead to
accelerated membrane weakening through:
1. Increased collagenase and protease activity
2. An increase in local cytokines
Pathophysiology
Pathophysiology of PROM
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PROM
9
3. Bacterial invasion can facilitate membrane rupture through:
 Direct release of proteases and
 Stimulation of a host inflammatory response that results in the elaboration of local
cytokines, MMPs, and prostaglandins
3. Imbalance in the interaction between matrix metalloproteinases (MMP-1, MMP-2, MMP-9) and
tissue inhibitors of matrix metalloproteinases (TIMP-1, TIMP-3)
 Matrix metalloproteases (MMPs) decrease membrane strength by increasing collagen
degradation
APPROACH TO MANAGEMENT OF
PROM
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PROM
10
1. Confirm the diagnosis of ROM
2. Evaluate for the presence of chorioamnionitis and labor
3. Determine the gestational age and evaluate the fetal condition
4. Subsequent management based on the above findings
Confirm diagnosis of PROM
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PROM
11
1. History:
The classic clinical presentation of PROM is a sudden "gush" of clear or
pale-yellow fluid from the vagina
Patients can present with intermittent or constant leaking of small
amounts of fluid or
Just a sensation of wetness within the vagina or on the perineum
6/15/2024
PROM
12
Observation of amniotic fluid coming out of the cervical canal
If amniotic fluid is not immediately visible, the woman can be asked to push on
her fundus, valsalva, or cough to provoke leakage of amniotic fluid from the
cervix
 Pooling in the vaginal fornix needs further evaluation as the collection may be
due to excessive vaginal discharge or urine
♥ Presence of meconium, vernix caseosa or lanugo hair in the fluid pooling
2. Sterile speculum examination
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PROM
13
Note that sterile speculum examination can also help to check for the presence
of cord prolapse and to assess cervical status
Amniotic fluid can also be sent for maturity tests (if available)
Digital examination should be avoided because it may decrease the latency
period and increase the risk of chorioamnionitis
If PROM is not obvious after visual inspection, examine the fluid for ferning or
PH.
2. speculum examination…
3. Ferning test:
6/15/2024
PROM
14
Obtain fluid by swabbing the posterior fornix (avoid
cervical mucus to decrease chance of false positive
result)
Spread some fluid on a slide & let it dry for at least
10 minutes
Amniotic fluid produces a delicate a fern-leaf pattern
(arborization) ( High Na+ and protein contents)
Typical ferning pattern of dried
amniotic fluid
4. pH testing of fluid (Nitrazine paper) test:
6/15/2024
PROM
15
Hold a piece of nitrazine paper in a hemostat (artery forceps) & touch it against
the fluid pooled on the speculum blade
 A change from yellow to blue indicates presence of amniotic fluid (a PH >6 - 6.5)
 False negative tests results can occur when leaking is intermittent or the
amniotic fluid is diluted by other vaginal fluids
False positive results can be due to the presence of alkaline fluids in the vagina,
such as blood, seminal fluid, or soap
 In addition, the pH of urine can be elevated to near 8.0 if infected with Proteus
species.
6/15/2024
PROM
16
5. Pad test:
 Can be helpful when there is no pooling & no leakage from cervix.
 Place a vaginal pad over the vulva & examine it one hour later visually & by odor.
 Wetting with no urine and no vaginal discharge (vaginitis) may suggest PROM.
 If the diagnosis remains in question, repeat the test
6. Ultrasound examination: Performed to look for reduction of amniotic fluid volume
7. Dye test; a definitive dx in equivocal cases,
– Indigo caramine is instilled into the amnotic cavity,(1 mL in 9 mL sterile normal saline)
– tampoon placed in the vagina inspected after 30 min for blue staining
Diagnosi
s
6/15/2024
PROM
17
Evaluate for the presence of chorioamnionitis and labor
6/15/2024
PROM
18
Clinical signs and symptoms of chorioamnionitis
Once PROM is confirmed, a careful physical examination is necessary to
search for other signs of infection
The criteria for the diagnosis of clinical chorioamnionitis include:
Maternal fever
Tachycardia
Leukocytosis
Uterine tenderness
Offensive vaginal discharge and
Fetal tachycardia
Chorioamnionitis…
6/15/2024
PROM
19
Laboratory tests
A. Complete blood count:
Maternal leukocytosis (WBC >12,000 /mm3) or the presence of a left shift (> 90%)
often supports the diagnosis of chorioamnionitis.
B. C-reactive protein (CRP): High level is associated with a higher risk of
chorioamnionitis in the setting of PPROM.
C. Amniotic fluid testing: for the diagnosis of subclinical chorioamnionitis and to
confirm lung maturity
Sub clinical chorioamnionitis
 Amniocentesis: intra-mniotic infection is present if:
1. Culture: bacterial colony count > 102 / ml fluid
2. Presence of bacteria on gram stain
3. Glucose level<15 mg/dl
4. WBC> 100/ml
Determine the GA and evaluate the fetal condition
6/15/2024
PROM
21
Confirm the gestational age of the fetus (using LMP, early
U/S).
Perform ultrasound to determine fetal presentation and lie.
Electronic fetal monitoring to identify occult umbilical cord
compression
Do biophysical profile or NST
Subsequent Management
6/15/2024
PROM
22
1. Expedite delivery: Indications
Onset of labor, gestation age ≥ 37wks
Evidence for non-reassuring fetal status
Evidence for chorioamnionitis
 Lethal congenital anomalies
Intrauterine fetal death (IUFD)
 If there is high risk of cord prolapse (e.g., transverse lie) and Abruptio placenta
Note: if the GA is < 34 weeks and both the feto-maternal conditions are stable,
expectant management can be considered for abruption placenta in a setting
where close follow up is possible.
2. Expectant management
6/15/2024
PROM
23
Admit to the ward (Transfer patients to higher health facility with newborn
intensive care (NICU), if possible).
Avoid digital cervical (pelvic) examination
Advise bed-rest, to potentially enhance amniotic fluid re-accumulation & possibly
delay onset of labor.
6/15/2024
PROM
24
Corticosteroids: for lung maturity
Betamethasone 12 mg IM 24 hours apart for two doses or
Dexamethasone 6 mg IM BID for four doses.
The first dose of corticosteroids should be administered even if the ability
to give the second dose is thought to be unlikely… improves fetal lung
maturity and chances of neonatal survival
Antenatal corticosteroid therapy should not be administered in women with
chorioamnionitis
2. Expectant management...
6/15/2024
PROM
25
Corticosteroid repeat dose
Administer a single repeat dose of betamethasone or
dexamethasone to pregnancies up to 34 weeks of gestation with all
of the following characteristics,
1. Clinically estimated to be at high risk of delivery within the next
seven days
2. Prior exposure to antenatal corticosteroids at least 14 days earlier
3. Initial course of antenatal corticosteroids administered at ≤28 weeks of
gestation
6/15/2024
PROM
26
Antibiotics
Ampicillin 2gm IV QID and Erythromycin 250 mg P.O QID for 48 hours
followed by
Amoxicillin 500 mg P.O TID & Erythromycin 250 mg. P.O QID for 5 days.
Azithromycin may be substituted for Erythromycin with regimen of 500mg
PO on day 1 followed by 250mg PO daily for 6 days.
If there is onset of labor and in the absence of signs of uterine infection,
discontinue antibiotics after delivery
2. Expectant management
6/15/2024
PROM
27
Neuroprotection:
If GA is <32 weeks and preterm birth is likely within the next 24 hrs
4 g Mgso4 loading of over 20 minutes and a maintenance dose of 1 g/hour
The mechanism for the neuroprotective effects of Mgso4 not well understoodbut
the proposed mechanisms are:
By stabilizing blood pressure and normalizing cerebral blood flow
Prevention of injury by stabilization of neuronal membranes
Protection against oxidative injury via antioxidant effects
Protection against inflammatory injury via anti-inflammatory effects
2. Expectant management
6/15/2024
PROM
28
Monitoring and Follow up
Maternal pulse & temperature - every 4-6 hours
FHR - every 4-6hrs (& if possible CTG 2x daily)
Uterine tenderness or irritability (or pain) - daily
WBC count & differential - changes, every 2-3 days
Amniotic fluid appearance & odor - daily
If possible, examine for presence of subclinical intraamniotic infection with
amniocentesis.
2. Expectant management....
Rx of chorioamnionitis:
6/15/2024
PROM
29
Option 1: Ampicillin 2 g IV every QID PLUS gentamycin 5 mg/kg body weight IV
every 24 hours ± metronidazole 500 mg IV TID
Option 2: Ceftriaxone 1 gm IV BID for 10 days ± metronidazole 500 mg IV TID
Shift the antibiotics to PO medication after the symptoms and signs of infection
have subsided for 48 hours.
Metronidazole should be added if the route of delivery is CS to cover anaerobic
organisms.
 Emergency priming and induction of labor if there is no contraindication for
vaginal delivery/perform C/S
Newborn requires evaluation and management in NICU
Labor and delivery for term PROM without infection:
6/15/2024
PROM
30
If cervix is favorable, labor is induced
If cervix is unfavorable, ripen the cervix (preferably with PO
misoprostol).
If contraindications to vaginal delivery ---cesarean delivery is
performed
Antibiotic (Ampicillin 2gm IV QID) --- continue throughout labor and
for at least one dose after delivery
Follow for features of chorioamnionitis
PROM- DDX
Stress Urinary incontinence
Vaginal discharge
Leucorrhea gravidarum or pathological discharge
Perspiration
Complications of PROM
Fetal and Neonatal
Infection
Umbilical cord compression as
a result of oligohydramnios,
Cord prolapse
Fetal death
Preterm birth and associated
complications (RDS, NEC,
etc)
Neonatal infections
long-term sequelae such as
cerebral palsy
Pulmonary hypoplasia and
Restriction deformities
Maternal:
 Abruptio placentae
 Chorioamnionitis
 Sepsis
 Higher risk for
cesarean delivery
 Retained placenta and
hemorrhage
6/15/2024
PROM
33
Quiz
6/15/2024
PROM
34
1. List at least six complications of PROM (2point)???
2. List at least four criteria to diagnose clinical chorioamnionitis (3point) ???

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13. PROM premature rupture of membranes

  • 1. By: Tebabere M. (MSc in clinical midwifery) 6/15/2024 PROM 1 Premature/pre-labor rupture of the membranes (PROM)
  • 2. 6/15/2024 PROM 2 1 Definition premature rapture of membrane Types Risk factors 2 Pathophysiology Differential diagnosis 3 Diagnosis and management Complication Presentation outline
  • 3. Objectives 6/15/2024 PROM 3 After the completion of this session, you will able to: Define premature rapture of membrane Identify the risk factors of premature rapture of membrane Describe the pathophysiology of premature rapture of membrane Explain the diagnosis approach of premature rapture of membrane Identify the how to manage premature rapture of membrane
  • 4. 6/15/2024 PROM 4 Definition:  Membrane rupture that occurs spontaneously before the onset of labor is described as premature rupture of the membranes (PROM) regardless of the gestational age at which it occurs  Prolonged PROM is rupture of membranes for > 12 hours Latency period : the interval b/n the rupture of the membranes and the onset of labor  The duration varies inversely with the gestational age Almost 90% of women at term will be in spontaneous labor within 24 hrs But, at 28 to 34 weeks only 50% will go into labor within 24 hrs and 80% within 1 Premature rupture of the membranes (PROM)
  • 5. PROM…. 6/15/2024 PROM 5 Classification 1. Term PROM: is rupture of membranes at or after 37 completed weeks of gestation 2. Preterm PROM: is rupture of membranes before 37 completed weeks of gestation Incidence:  PROM complicates about 8% to 10% of pregnancies.  Preterm PROM that occurs before 37 weeks’ gestation affects about 1% of deliveries overall, and it is over twofold more common in blacks
  • 6. 6/15/2024 PROM 6  Mechanical factors: Multifetal gestation, polyhydramnios, pulmonary diseases, cervical conization/ LEEP/ cerclage  Urogenital infections: UTI, cervicitis,group B β-hemolytic Streptococcus (GBS) cervical colonization, bacterial vaginosis  Previous history of preterm PROM, preterm labor  Second and third trimester bleeding (e.g. abruptio placenta)  Other risk factors: Low socioeconomic status, nutritional deficiencies (copper and ascorbic acid), low BMI, smoking and connective tissue disorders (e.g., Ehlers-Danlos syndrome) Risk factors
  • 7. 6/15/2024 PROM 7 Pathophysiology Fetal membrane anatomy and physiology The fetus develops within the amniotic sac, which is surrounded like a balloon by the fetal membranes The membranes consist of a thin amnion layer that lines the amniotic cavity and a thicker outer chorion directly apposed to the maternal decidua The amnion fuses to the chorion near the end of the first trimester of pregnancy, and these layers are subsequently attached by a collagen-rich connective tissue Together, the amnion and chorion are stronger than either layer independently
  • 8. 6/15/2024 PROM 8 The pathogenesis of spontaneous membrane rupture is not completely understood  The strength and integrity of fetal membranes derive from extracellular membrane proteins, including collagens, fibronectin, and laminin Preterm PROM likely results from a variety of factors that ultimately lead to accelerated membrane weakening through: 1. Increased collagenase and protease activity 2. An increase in local cytokines Pathophysiology
  • 9. Pathophysiology of PROM 6/15/2024 PROM 9 3. Bacterial invasion can facilitate membrane rupture through:  Direct release of proteases and  Stimulation of a host inflammatory response that results in the elaboration of local cytokines, MMPs, and prostaglandins 3. Imbalance in the interaction between matrix metalloproteinases (MMP-1, MMP-2, MMP-9) and tissue inhibitors of matrix metalloproteinases (TIMP-1, TIMP-3)  Matrix metalloproteases (MMPs) decrease membrane strength by increasing collagen degradation
  • 10. APPROACH TO MANAGEMENT OF PROM 6/15/2024 PROM 10 1. Confirm the diagnosis of ROM 2. Evaluate for the presence of chorioamnionitis and labor 3. Determine the gestational age and evaluate the fetal condition 4. Subsequent management based on the above findings
  • 11. Confirm diagnosis of PROM 6/15/2024 PROM 11 1. History: The classic clinical presentation of PROM is a sudden "gush" of clear or pale-yellow fluid from the vagina Patients can present with intermittent or constant leaking of small amounts of fluid or Just a sensation of wetness within the vagina or on the perineum
  • 12. 6/15/2024 PROM 12 Observation of amniotic fluid coming out of the cervical canal If amniotic fluid is not immediately visible, the woman can be asked to push on her fundus, valsalva, or cough to provoke leakage of amniotic fluid from the cervix  Pooling in the vaginal fornix needs further evaluation as the collection may be due to excessive vaginal discharge or urine ♥ Presence of meconium, vernix caseosa or lanugo hair in the fluid pooling 2. Sterile speculum examination
  • 13. 6/15/2024 PROM 13 Note that sterile speculum examination can also help to check for the presence of cord prolapse and to assess cervical status Amniotic fluid can also be sent for maturity tests (if available) Digital examination should be avoided because it may decrease the latency period and increase the risk of chorioamnionitis If PROM is not obvious after visual inspection, examine the fluid for ferning or PH. 2. speculum examination…
  • 14. 3. Ferning test: 6/15/2024 PROM 14 Obtain fluid by swabbing the posterior fornix (avoid cervical mucus to decrease chance of false positive result) Spread some fluid on a slide & let it dry for at least 10 minutes Amniotic fluid produces a delicate a fern-leaf pattern (arborization) ( High Na+ and protein contents) Typical ferning pattern of dried amniotic fluid
  • 15. 4. pH testing of fluid (Nitrazine paper) test: 6/15/2024 PROM 15 Hold a piece of nitrazine paper in a hemostat (artery forceps) & touch it against the fluid pooled on the speculum blade  A change from yellow to blue indicates presence of amniotic fluid (a PH >6 - 6.5)  False negative tests results can occur when leaking is intermittent or the amniotic fluid is diluted by other vaginal fluids False positive results can be due to the presence of alkaline fluids in the vagina, such as blood, seminal fluid, or soap  In addition, the pH of urine can be elevated to near 8.0 if infected with Proteus species.
  • 16. 6/15/2024 PROM 16 5. Pad test:  Can be helpful when there is no pooling & no leakage from cervix.  Place a vaginal pad over the vulva & examine it one hour later visually & by odor.  Wetting with no urine and no vaginal discharge (vaginitis) may suggest PROM.  If the diagnosis remains in question, repeat the test 6. Ultrasound examination: Performed to look for reduction of amniotic fluid volume 7. Dye test; a definitive dx in equivocal cases, – Indigo caramine is instilled into the amnotic cavity,(1 mL in 9 mL sterile normal saline) – tampoon placed in the vagina inspected after 30 min for blue staining
  • 18. Evaluate for the presence of chorioamnionitis and labor 6/15/2024 PROM 18 Clinical signs and symptoms of chorioamnionitis Once PROM is confirmed, a careful physical examination is necessary to search for other signs of infection The criteria for the diagnosis of clinical chorioamnionitis include: Maternal fever Tachycardia Leukocytosis Uterine tenderness Offensive vaginal discharge and Fetal tachycardia
  • 19. Chorioamnionitis… 6/15/2024 PROM 19 Laboratory tests A. Complete blood count: Maternal leukocytosis (WBC >12,000 /mm3) or the presence of a left shift (> 90%) often supports the diagnosis of chorioamnionitis. B. C-reactive protein (CRP): High level is associated with a higher risk of chorioamnionitis in the setting of PPROM. C. Amniotic fluid testing: for the diagnosis of subclinical chorioamnionitis and to confirm lung maturity
  • 20. Sub clinical chorioamnionitis  Amniocentesis: intra-mniotic infection is present if: 1. Culture: bacterial colony count > 102 / ml fluid 2. Presence of bacteria on gram stain 3. Glucose level<15 mg/dl 4. WBC> 100/ml
  • 21. Determine the GA and evaluate the fetal condition 6/15/2024 PROM 21 Confirm the gestational age of the fetus (using LMP, early U/S). Perform ultrasound to determine fetal presentation and lie. Electronic fetal monitoring to identify occult umbilical cord compression Do biophysical profile or NST
  • 22. Subsequent Management 6/15/2024 PROM 22 1. Expedite delivery: Indications Onset of labor, gestation age ≥ 37wks Evidence for non-reassuring fetal status Evidence for chorioamnionitis  Lethal congenital anomalies Intrauterine fetal death (IUFD)  If there is high risk of cord prolapse (e.g., transverse lie) and Abruptio placenta Note: if the GA is < 34 weeks and both the feto-maternal conditions are stable, expectant management can be considered for abruption placenta in a setting where close follow up is possible.
  • 23. 2. Expectant management 6/15/2024 PROM 23 Admit to the ward (Transfer patients to higher health facility with newborn intensive care (NICU), if possible). Avoid digital cervical (pelvic) examination Advise bed-rest, to potentially enhance amniotic fluid re-accumulation & possibly delay onset of labor.
  • 24. 6/15/2024 PROM 24 Corticosteroids: for lung maturity Betamethasone 12 mg IM 24 hours apart for two doses or Dexamethasone 6 mg IM BID for four doses. The first dose of corticosteroids should be administered even if the ability to give the second dose is thought to be unlikely… improves fetal lung maturity and chances of neonatal survival Antenatal corticosteroid therapy should not be administered in women with chorioamnionitis 2. Expectant management...
  • 25. 6/15/2024 PROM 25 Corticosteroid repeat dose Administer a single repeat dose of betamethasone or dexamethasone to pregnancies up to 34 weeks of gestation with all of the following characteristics, 1. Clinically estimated to be at high risk of delivery within the next seven days 2. Prior exposure to antenatal corticosteroids at least 14 days earlier 3. Initial course of antenatal corticosteroids administered at ≤28 weeks of gestation
  • 26. 6/15/2024 PROM 26 Antibiotics Ampicillin 2gm IV QID and Erythromycin 250 mg P.O QID for 48 hours followed by Amoxicillin 500 mg P.O TID & Erythromycin 250 mg. P.O QID for 5 days. Azithromycin may be substituted for Erythromycin with regimen of 500mg PO on day 1 followed by 250mg PO daily for 6 days. If there is onset of labor and in the absence of signs of uterine infection, discontinue antibiotics after delivery 2. Expectant management
  • 27. 6/15/2024 PROM 27 Neuroprotection: If GA is <32 weeks and preterm birth is likely within the next 24 hrs 4 g Mgso4 loading of over 20 minutes and a maintenance dose of 1 g/hour The mechanism for the neuroprotective effects of Mgso4 not well understoodbut the proposed mechanisms are: By stabilizing blood pressure and normalizing cerebral blood flow Prevention of injury by stabilization of neuronal membranes Protection against oxidative injury via antioxidant effects Protection against inflammatory injury via anti-inflammatory effects 2. Expectant management
  • 28. 6/15/2024 PROM 28 Monitoring and Follow up Maternal pulse & temperature - every 4-6 hours FHR - every 4-6hrs (& if possible CTG 2x daily) Uterine tenderness or irritability (or pain) - daily WBC count & differential - changes, every 2-3 days Amniotic fluid appearance & odor - daily If possible, examine for presence of subclinical intraamniotic infection with amniocentesis. 2. Expectant management....
  • 29. Rx of chorioamnionitis: 6/15/2024 PROM 29 Option 1: Ampicillin 2 g IV every QID PLUS gentamycin 5 mg/kg body weight IV every 24 hours ± metronidazole 500 mg IV TID Option 2: Ceftriaxone 1 gm IV BID for 10 days ± metronidazole 500 mg IV TID Shift the antibiotics to PO medication after the symptoms and signs of infection have subsided for 48 hours. Metronidazole should be added if the route of delivery is CS to cover anaerobic organisms.  Emergency priming and induction of labor if there is no contraindication for vaginal delivery/perform C/S Newborn requires evaluation and management in NICU
  • 30. Labor and delivery for term PROM without infection: 6/15/2024 PROM 30 If cervix is favorable, labor is induced If cervix is unfavorable, ripen the cervix (preferably with PO misoprostol). If contraindications to vaginal delivery ---cesarean delivery is performed Antibiotic (Ampicillin 2gm IV QID) --- continue throughout labor and for at least one dose after delivery Follow for features of chorioamnionitis
  • 31. PROM- DDX Stress Urinary incontinence Vaginal discharge Leucorrhea gravidarum or pathological discharge Perspiration
  • 32. Complications of PROM Fetal and Neonatal Infection Umbilical cord compression as a result of oligohydramnios, Cord prolapse Fetal death Preterm birth and associated complications (RDS, NEC, etc) Neonatal infections long-term sequelae such as cerebral palsy Pulmonary hypoplasia and Restriction deformities Maternal:  Abruptio placentae  Chorioamnionitis  Sepsis  Higher risk for cesarean delivery  Retained placenta and hemorrhage
  • 34. Quiz 6/15/2024 PROM 34 1. List at least six complications of PROM (2point)??? 2. List at least four criteria to diagnose clinical chorioamnionitis (3point) ???