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PROM-PPROM

By: Izyan ‘Izzati binti Omar


M151044234
DEFINITION
• Prelabour Rupture of Membrane (PROM):
- rupture of membranes before the onset of labour
at or beyond 37 weeks of gestation
(≥37 weeks)
• Premature Prelabour Rupture of Membrane
(PPROM):
- rupture of membranes before the onset of
labour, occurs before 37 weeks of gestation
(<37 weeks)
AETIOLOGY & RISK FACTORS
• Increased friability of the membranes
• Decreased tensile strength of the membranes
• Polyhydramnios
• Multiple pregnancy
• Prior preterm labour
• Cervical incompetence (cervical length < 2.5cm)
• *Infection (chorioamnionitis, UTI, lower GTI)
• *Sexual transmitted disease
* Metabolites and PG released by the bacteria weakens and causes rupture of the membrane
DIAGNOSIS
• History
• Examinations
• Investigations
History
• Report of a “gush of fluid” vaginally
• Usually followed by a more-or-less continuous
dribble
• Contractions
Examinations
Sterile speculum examination
• Pooling of fluid in posterior vagina
• Fluid may be seen trickling through external
os and dilatation can be assessed

• Digital vaginal examinations should be


avoided
Investigations
1. Test alkalinity of the fluid by:
• Litmus
• Nitrazine test (turns dark blue)

Vaginal
Amniotic fluid
secretion
(>7.1)
(4.5-6.0)

Urine
(≤6.0)
Nitrazine test result
Litmus test result
But false-positive may occur in Nitrazine test:
– Basic urine
– Semen
– Blood contamination
2. Fern test

• Amniotic fluid is placed on a slide and is


allowed to dry in room air
• Observe under microscope
• The resultant pattern resembles the leaves of
fern plant
3. AmniSure (rapid immunoassay)
• Accurate
• Detects trace amount of placental alpha
microglobulin-1 protein in aminiotic fluid after
fetal membrane rupture
4. USS
• To support the diagnosis
– Assessment of amniotic fluid (less than expected)
• To determine:
– Gestational age
– Fetal presentation
5. CTG
• To assess fetal well-being

6. High vaginal swab for culture


• Especially for β-hemolytic streptococci
DIFFERENTIAL DIAGNOSIS
• Urine loss:
– incontinence
– UTI
• Increased vaginal secretions in pregnancy
(physiologic)
• Increased cervical discharge (infection)
• Exogenous fluid (such as semen)
COMPLICATIONS
• PROM:
– Maternal sepsis
– Endometritis
– Cord prolapse
– Placental abruption
– Retained placenta
• PPROM:
– Lead to preterm labour and associated with neonatal
sepsis, respiratory distress syndrome (RDS),
intraventricular hemorrhage (IVH), and necrotizing
enterocolitis (NEC)
– Fetal pulmonary hypoplasia
– Skeletal malformations
MANAGEMENT
• Patient is put to bed rest
• Sterile vulval pad is applied to observe any
further leakage
• Once the diagnosis is confirmed, management
depends on
– Gestational age of the fetus
– Fetal presentations
– Assessment of fetal well-being (Fetal distress 
LSCS)
– Chorioamnionitis  LSCS
– Degree of fetal maturity
• Maternal pulse, temperature and fetal heart
rate are monitored 4 hourly.
Signs and symptoms of chorioamnionitis:
– Fever
– Maternal tachycardia
– Fetal tachycardia
– Uterine tenderness
MANAGEMENT
• Before viability (<24 weeks)
– Expectant management
– Bed rest to encourage resealing
– Induce labour

• Preterm viable (24-35 weeks)


– Expectant management
– Steroids : Dexamethasone (fetal lung maturity)
– Tocolytic agents
– Antibiotics (erythromycin or ampicillin)
– Group B streptococcus prophylaxis

*The main aim is to manage the case conservatively till the 35th week when lung
maturity mostly occurs and the baby can survive
• >36 weeks
– Proceed to delivery
• Usually by IOL if spontaneous labour doesn’t occur in
24 hrs
– Group B streptococcus prophylaxis
THANK YOU
References