PREMATURE RUPTURE OF

MEMBRANES (PROM)

KABERA René, MD
Resident PGY II- Family and Community Medicine
Obs-Gyn. Dept Ruhengeri Hospital
Feb 2010.
 ESSENTIALS OF DIAGNOSIS

• History of a gush of fluid from the vagina or

watery vaginal discharge.

• Demonstration of amniotic fluid leakage from

the cervix.
• ≥1h before the onset of labor.

KABERA René ,MD PGY II FAMCO NUR

 General Considerations

• Rupture of the membranes may happen at

any time during pregnancy.
• It becomes a problem if the fetus is preterm
(preterm) .
• >24 Hrs, prolonged premature rupture of
membranes -time between rupture of the
membranes and the onset of labor is.

KABERA René ,MD PGY II FAMCO NUR

 General considerations c’t
• Causes

Infections .

Cervix incompetency.

Hydramnios …
• 10.7 % in all pregnancy.
• 94% mature fetus (>2500 grs) ,5% premature
fetus (1000-2500 grs),immature fetus
0.5%(<1000 grs).
KABERA René ,MD PGY II FAMCO NUR
 Pathophysiology
• PROM is an important cause of preterm labor,
prolapse of the cord, placental abruption, and
intrauterine infection.
• In extremely prolonged PROM, the fetus may
have an appearance similar to that of Potter's
syndrome (eg, extraordinary flexion, wrinkling of
the skin).
• If PROM occurs at less than 26 weeks' EGA, it can
cause pulmonary hypoplasia and limb positioning
defects in the newborn.
KABERA René ,MD PGY II FAMCO NUR
 Clinical findings
• Symptoms
• The patient usually reports a sudden gush of
fluid or continued leakage.
• Reduced size of the uterus, and increased
prominence of the fetus to palpation.
• Sterile Speculum Examination
• Pooling , Nitrazine test, Ferning.

KABERA René ,MD PGY II FAMCO NUR

 Lab test
• CBC , CRP, U/S, Amniocentesis for lung
maturation
• Amniotitis : most common germ is
streptococci B-fever ,leukocytosis (>16000
WBC),uterine tenderness, tachycardia ( >100
btm-mother,>160 btm-fetus ),foul smelling
amniotic liquid .

KABERA René ,MD PGY II FAMCO NUR

 Management
• A.Amniotitis :
delivery regardless of gestational age. Broad-
spectrum antibiotics should be started. if no labor
, labor should be induced to expedite delivery.
• B. Term Pregnancy Without Amnionitis:
• Nonintervention is an acceptable initial course of
treatment, but if the patient does not go into
labor within 6-12 hours after PROM, labor should
be induced to minimize the risk of infection.
KABERA René ,MD PGY II FAMCO NUR
 Management c’t
• C. Preterm Pregnancy Without Amnionitis
Pregnancies beyond 33-34 weeks' EGA can be managed
as a term pregnancy because there is no evidence that
antibiotics, corticosteroids, or tocolytics improve
outcome in these patients.

• Pregnancies prior to 24 weeks' EGA with PROM have

extremely low rates of fetal salvage with considerable
maternal risk.
Furthermore, at this early gestational age, steroids,
tocolytics, and antibiotics have no proven benefit.
KABERA René ,MD PGY II FAMCO NUR
 Management c’t
• For pregnancies with PROM between 24 and
32 weeks' EGA.
• Antibiotics.
• Corticosteroids.
• Tocolytics :In the preterm PROM patient
should be limited to 48 hours duration.

KABERA René ,MD PGY II FAMCO NUR

 References
• Current Obs-Gyn diagnosis and treatment.2003
• Williams Obstetrics .2005
• The Merck manual of diagnosis and therapy.1999

KABERA René ,MD PGY II FAMCO NUR

Thank you
Murakoze

KABERA René ,MD PGY II FAMCO NUR