Transcript PROM.pptx

Premature
Rupture of Membranes
Hazem Al-Mandeel, M.D
Course 481
Obstetrics and Gynecology Rotation
Definition
Premature rupture of membranes (PROM) is a
spontaneous rupture of membranes prior to
onset of labor at any gestational age
 Preterm PROM if it occurs prior to 38 wks of
gestation (other names: prelabor preterm
ROM)
 Etiology is unknown (? subclinical infection)
 Risk Factors include:
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◦ Vaginal or cervical infection
◦ Incompetent cervix
◦ Multiple gestation
Diagnosis
History of: vaginal loss of fluid
 Dx is confirmed by vaginal examination (sterile
speculum)
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looking for pooling of fluid in the vagina
Fluid coming out from cervical os
Nitrazine (pH) test
Ferning test
Obstetrical ultrasound can help in diagnosis
especially if the amniotic fluid volume is low
 Lab tests doesn’t always help in the
management
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Management of PROM
Management of PROM in preterm fetuses
depends on the balance between the risks of
preterm delivery and risks of mother or fetal
infection/sepsis
 Risks of PPROM include:
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Preterm delivery and neonatal prematurity syndrome
Maternal/fetal infection (chorioamnionitis)
Abruptio placenta
Cord prolapse
If early PROM (<24wks)  pulmonary hypoplasia
and limb contractures
Management of PROM
If PROM occurs at 36 wks or more  consider
delivery because risks outweigh benefits
 If PROM occurs before 36 wks, consider two
options:
1. Conservative/Expectant management
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If benefits outweigh any potential risks
Interventional treatment/Delivery
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In cases of confirmed chorioamnionitis
In cases of fetal compromise
Management of PPROM
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Conservative management can be continued
until the fetus becomes mature (confirmed lung
maturity or 36 weeks) or the risks become
higher
Admit patient to hospital till delivery
Give antenatal corticosteroids
Start antibiotics
Serial obstetrical ultrasound and non-stress test
Use tocolytic (to have time for corticosteroids
admin)
Consider outpatient management only if reliable
Management of Chorioamnionitis
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Start I.V broad-spectrum antibiotics
Prepare for delivery by induction of labor if no
fetal compromise is diagnosed
Consider cesarean section if fetus not tolerating
labor
Inform NICU for neonatal admission and
management
Continue antibiotics for a minimum of 7 days