PROM

PREMATURE RUPTURE OF THE MEMBRANES

Premature rupture of membranes (PROM) :

rupture of the fetal membranes before the onset of labor.

Preterm PROM (PPROM) : membrane rupture before 37 weeks’ gestation

Preterm PROM : 3 % of pregnancies and leads to one third of preterm births.

Increases the risk of prematurity and leads to a number of other perinatal and

neonatal complications, including a 1 to 2 % risk of fetal death

Risk Factors

• Black patients are at increased risk compared with white patients.

• Lower socioeconomic status

• Smokers

• Sexually transmitted infections

• Previous preterm delivery

• Uterine distension

• Cerclage

• Amniocentesis.

DIAGNOSIS

History taking :

• A sudden gush of fluid with continued leakage

• Contraction ?

• Bleeding vaginally ?

• Has had intercourse recently ?

• Fever.

It is important to verify the patient’s estimated due date ® treatment.

Physical examination :

• Perform a speculum examination

– evaluate if any cervical dilation and effacement

– Evidence of fluid pooling in the vagina, or leaking

– from the cervical os when thepatient coughs or when fundal pressure

is applied

• Nitrazine paper & fern test : 90 %

Avoid performing a digital cervical examination

• increase morbidity and mortalitas

Laboratory

• Culture

• Vaginal swab

USG

• Amniotic fluid index (AFI)

• Gestational age

• Number of fetus

• Placental location

• Estimated fetal weight

• Anomaly

Amniocentesis : indigo carmine

MANAGEMENT

Corticosteroid

• Effective to decrease perinatal morbidity and mortality.

(RDS, IVH, NEC ¯)

• Betamethasone im 12 mg every 24 hours for two days or

dexamethasone im 6 mg every12 hours for two days.

• The National Institutes of Health < 30 to 32 weeks’ gestation,

assuming fetal viability and no evidence of intra-amniotic infection.

• Administration of corticosteroids after 34 weeks’ gestation is not

recommended unless there is evidence of fetal lung immaturity

Antibiotic

• The National Institute of Child Health and Human Development

– 2 grams of ampicillin and 250 mg of erythromycin IV/6 hr for

48 hours, followed by 250 mg amoxicillin +

333 mg of erythromycin/8hr

for 5 – 7 days.

Tocolytic