Premature Rupture of Memberanes


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Premature Rupture of Memberanes

  1. 1.  PROM is defined as the rupture of the chorion & amniotic sac more than one hour before the onset of labor(uterine contractions).  uterine contractions of sufficient frequency and intensity to result in progressive effacement and dilation of the cervix  PROM is considered prolonged when it occurs more than 18 or 24 hours before labor.
  2. 2.  PROM is considered preterm when it occurs before 37 weeks gestation, and is called Preterm Premature Rupture of Membranes (or PPROM)  Latent phase :  the period between rupture of membranes and beginning of uterine contractions
  3. 3. 5-10 % of all term pregnancy PROM. PPROM in 1% of all pregnancies PROM is accelerator of 1/3 of preterm pregnancies In pt with history of PROM the incidence of recurrence is 32%
  4. 4.  Idiopahtic  Infection  Over distention (Multiple preg, Polyhydramnios)  Antepartum Haemorrhage & abruption  Intercurrent illness  Cervical weakness
  5. 5. Bacterial infection, (Genital tract infection) Smoking, Drugs abuse (cocaine) Antepartum bleeding Anatomic defect in the structure of the amniotic sac, uterus, or cervix  Multiple pregnancy  Acute Inflammation of Placenta  Maternal risk factors  Chorioamnionitis or sepsis  Emotional states of fear and pre labor rupture of membranes at term  Fetal factors  prematurity, infection, cord prolapsed ,mal presentation or genetic mutations.    
  6. 6. Differential diagnosis — Urinary Tract Infection Urinary incontinence,  Vaginal discharge, and perspiration.  Placental Abruption Constipation Renal agenesis, Obstructive uropathy, Utero-placental insufficiency Reductions in amniotic fluid volume Gastroenteritis
  7. 7. Infection: Increase Pulse & temperature & a flushed appearance abdominal examination may reveal a Clinical suspicion of oligohydramnios or uterine tenderness if chorioamnionitis is present
  8. 8. •Maternal Steriod: Single course (two Inj 12-24 hours or 12mg I.M , 6mg/12hrsx4 doses) given between 24 & 34wks gestation & received within 7 days of delivery result improved neonatal outcomes Reduction in RDS in neonatal. Max benefit seen after 48 hrs or more than 7 days before delivery lead to benefit below 28 wks.
  9. 9.  50% contraction cease spontaneously  Delay preterm labour would improve fetal outcome without causing harm to mother or fetus  Almost no clinical benefit & only nifedipine may improve fetal outcome  Nifedipine 20mg PO then 10-20mg/6-8h PO according to uterine activity
  10. 10.  10 days course of Erythromycin  Iv AB (eg ampicillin 500mg/6h iv + Gentamicin 3-5mg/kg/8hrs) 5-7 days
  11. 11.  Gestational age over 36 weeks A. In absence of infection, fetal distress and abnormal lie, wait for 24 hours as about 90% of patients with PROM will pass into spontaneous labor. Prophylactic antibiotic can be given during this period. B. PGE2 and / or oxytocin is used for induction of labor in patients did not pass into labor after 24 hours.
  12. 12.  Gestational age between 34-36 weeks A. In absence of infection and fetal distress, wait for 48 hours as rupture of membrane itself will accelerates lung surfactant production and hence lung maturity. B. Induce labor after 48 hours with PGE2 and /or oxytocins. C. Prophylactic antibiotics are given during this period. D. Caesarean section is indicated in breech presentation < 36 weeks’ gestation.
  13. 13.  Gestational age between 28-34 weeks In absence of infection, the main aim is to manage the case conservatively till the 35th week when lung maturity mostly occurs and the baby can survive.
  14. 14. a. Rest in bed as long as there is escape of liquor with restriction of efforts later on particularly those that increase intraabdominal pressure. b. Temperature is recorded every 4 hours. c. Observation for malaise, abdominal pain, uterine tenderness and amount of escaped liquor on sterile vulval pads. d. Leucocytic count and C-reactive protein may be done every other day. e. Prophylactic antibiotics may be given although this is not advised by some authors as it may lead to colonisation of resistant strains of organisms in the genital tract. f .Tocolytic drugs: are given if uterine activity starts. g .Corticosteroid therapy: is given for 48 hours if labor was imminent or will be induced before 35 weeks.
  15. 15. Gestational age less than 28 weeks There is little chance of fetal survival and the condition is usually considered as inevitable abortion.