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- 1. PROM (Premature ruptureof membrane) Definition: Spontaneous rupture of membranes after 28 weeks of gestation before the onset of labor. Term PROM: Rupture of membranes after 37 weeks Preterm PROM: Before 37 weeks Prolonged PROM: Longer than 18 hrs/ 12 hrs. Latency period: Time between rupture of membranes to onset of labor.
- 2. Diagnosis History: complaint ofleakage of liquor as gush or slow leak followed by intermittent leakage Sterile speculum examination with or without valsalva maneuver( leakage or pooling) Nitrazine paper test: principle is alkaline nature of amniotic fluid(accuracy of approximately 93%) Became blueFalse +ve- blood, semen, alkaline urine, bacterial vaginosis,
- 3. Diagnosis Ferning pattern: Accuracyof diagnosis of PROM of approximately 96% False +ve: contamination by semen or cervical mucus False –ve : dry swab, contamination with blood at a 1:1 dilution, or not allowing sufficient time for the fluid to dry on the slide Ultrasound: support diagnosis & fetal wellbeing.
- 4. Investigations CBCUrine analysis(Culture &Sensitivity)High vaginal swab for culture & SensitivityBiophysical profileCTG for non-stress test
- 5. Differential diagnosis • Urinaryincontinence • Leucorrhea gravidarum • Vaginal discharge-pathological
- 6. Incidence • Average 5-10% of all deliveries and up to 30% of preterm deliveries. • Approximately 70% of cases of PROM occur in pregnancies at term. • PROM is the clinically recognized precipitating cause of about one third of all preterm births.
- 7. Causes (multifactorial) 1. Intrinsicmembrane weakness • Infections • Smoking • Malnutrition • Collagen Deficiency 2. Infection 3. Mechanical stress • Twin gestation • Polyhydramnios • Fetal Malformations 4. Unknown
- 8. Complications • Labor: Interm PROM labor starts in 24 hours in about 90%. In Preterm PROM, labor starts in 70- 80% of cases in one week time • Ascending infection • Increased incidence of cord prolapse • Fetal pulmonary hypoplasia • Prematurity • Operative delivery • Abruption placenta
- 9. Management of PROM AccuratediagnosisAvoid digital vaginal examination Bed restManagement depends on: • Gestational age • Presence or absence of labor • Infection or not • Fetal condition
- 10. Indications for pregnancytermination in PROM • Term PROM • Labor • Presence of infection • IUFD • Congenital anomalies of fetus incompatible to life • Abnormal fetal surveillance
- 11. Preterm PROM GA >34 weeks- is controversial either conservative management or termination GA< 34 weeks- conservative management
- 12. Components of conservativemanagement • Monitor maternal Pulse rate,Temp, BP • FHR every 4 hours • CBC,U/A,ESR/CRP twice per week • BPP/NST twice per week • Corticosteroids if less than 32/34 weeks • Administer antibiotics: ampicillin (iv)+ erythromycin X 48hrs followed by amoxacillin(po) & erythromycin to complete a total of seven days
- 13. Chorioamnionitis Criteria for clinicalchorioamnionitis: • Maternal temperature > 38o C • Uterine tenderness • Foul smelling amniotic fluid • High WBC count(>16000/18000) • Maternal &/ or fetal tachycardia
- 14. Management of chorioamnionitis Antibiotics: Ampicillin+Gentamycin+ clindamycin/metronidazole/chloramphenicol Ceftriaxone +/- metronidazole Terminate pregnancy: Vaginal route is preferred
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