Overview

• PROM → spontaneous rupture of membranes prior to onset of labour at term (ie. >37 weeks gestation).
  • Occurs in 8% of pregnancies.
  • Aetiology → natural physiological mechanisms. Braxton Hicks contractions and cervical ripening lead to weakening of the membrane.
• PPROM → spontaneous rupture of membranes prior to onset of labour in a pregancy <37 weeks.
  • Occurs in 2% of pregnancies. (Associated with around 40% of preterm deliveries).
  • Aetiology → weakening of the membranes strongly linked to an infective cause.
    • Risk Factors → smokers, STI, previous PPROM, multiple pregnancy, cervical incompetence.

<aside> 💡 RUPTURE OF MEMBRANES IN ABSENCE OF ANY UTERINE ACTIVITY (NO PAINFUL CONTRACTIONS).

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Making Diagnosis

Clinical Features

• Sudden gush of fluid PV.
• Contractions.
• Chorioamnionitis → maternal pyrexia + maternal tachycardia + fetal tachycardia.
  • Lower abdominal pain, malaise, abnormal vaginal discharge, reduced fetal movements.

Investigations

• 1st Line → speculum examination to look for pooling of amniotic fluid in the posterior vaginal vault.
  • If pooling of fluid not observed → test the fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin-like growth factor binding protein‑1 (IGFBP-1).
• Do not do bimanual → increases risk of infection.

Management Plan

• PROM (>37/40) (depends on amniotic fluid examined on speculum) ⇒
  • Admit to antenatal ward for speculum, 4 hrly temperature and 24 hr fetal monitoring.
  • Clear liquor → expectant management for 24 hours (60% will deliver). If nothing happens after 24 hours then induce labour.
  • Meconium → induce labour ASAP.
• PPROM (<37/40) ⇒
  • Admission to antenatal ward + regular observation to ensure chorioamnionitis (infection of placenta and amniotic fluid) is not developing.
  • Oral erythromycin (prophylactic Abx) for 10 days.
  • Antenatal corticosteroids (IM Betamethasone) → reduce risk of respiratory distress syndrome.
    • (Betamethasone or Dexamethasone only steroids for this use)
  • IV Magnesium Sulphate (neuroprotection of neonate) if birth is expected with next 24 hours.