(p)PROM

Risk Factors

• Previous PROM 

• Smoking 

• Polyhydramnios 

• Multiparity 

• Infection in the vagina, cervix or uterus 

• Previous cervical surgery 

Complications 

• Oligohydramnios 

  • • • Oligohydramnios <24 weeks gestation greatly increases risk of fetus developing pulmonary hypoplasia and death 

• Chorioamionitis 

  • • • Risk to both mother and fetus 

• Prematurity 

• Placental abruption 

Investigations  

Sterile speculum examination (avoid digital examination due to the risk of infection and delaying of labour)

• Visualise fluid draining from cervix/ pooling of fluid in posterior fornix

• High vaginal swab - may grow GBS (indication for antibiotics) or indicate bacterial vaginosis as cause of P-PROM 

Clinical diagnosis is usually made by maternal history and positive examination findings. 

Management of PROM 

• 95% patients undergo spontaneous labour <24 hours of membrane rupture

• At 24-48 hours: recommend induction of labour with prostaglandins or oxytocin 

• Antibiotics if maternal infection present

  • • • • Prophylactic antibiotic therapy controversial - occasionally used after no onset of spontaneous labour within 12 hours.

Management of P-PROM

<34 wks: 

• Expectant management (when chosen by mother): 4-8 hourly temperature and vaginal loss monitoring by woman - return to hospital if fever present 

• Prophylactic oral erythromycin should be given for 10 days (risk of sepsis and postnatal infection)

• Advise patient to avoid sexual intercourse 

• Corticosteroids should be administered (as gestation is less than 34+6 weeks) to reduce the risk of respiratory distress syndrome

>34 wks:

• Admission

• Regular observations to ensure chorioamnionitis is not developing and advise patient to avoid sexual intercourse 

• Prophylactic oral erythromycin should be given for 10 days (risk of sepsis and postnatal infection)

• Corticosteroids should be administered if gestation less than 34+6 weeks to reduce the risk of respiratory distress syndrome

• IOL and delivery should be recommended at 34 weeks of gestation - risk of maternal chorioamnionitis is increasing and fetal lungs have been given chance to mature

• If swab isolated GBS you would treat with penicillin/clindamycin during labour