Pemature Rupture of Membrane/Preterm Labour

PROM and PRETERM LABOUR is important chapter for medical and nurshing students

2. Spontaneous rupture of membrane any
time beyond viability of the foetus and
before onset of Labour is PROM.
When rupture of membrane occurs
before 37 completed weeks it is called
preterm PROM.
Rupture of membrane for >24hours
before delivery is known as prolonged
rupture of membrane.

3. Occur in about 10.7% of all pregnancies
In 94% of the cases the foetus is mature
Premature fetuses (1000-2500g) account
for about 5% of cases
While in about 0.5% of cases, the foetus is
immature (less than 1000g)

4. Exact cause is unknown.
↑ed friability and ↓ed tensile strength of
the membane.
Cervical incompetence
Polyhydramnios
Multiple gestation
Vaginal infections
Intrauterine infections-TORCH
Previous history of PROM
Abnormal lie and presentation

5. Sudden gush of fluid per vaginum.
Continuous leakage
Duration
Lower abdominal pain
Vaginal bleeding
Any predisposing factor
Any complication
Treatment.

6. General examination
Systemic examination (including uterine
content)
Avoid or minimal vaginal examination
Speculum examination

7. Necessary to confirm drainage.
Gush of liquor from cervical os.
Cervical effacement and dilatation.
Cord prolapse.
Meconium stained liquor.
Offensive.
Collect liquor for fetal lung maturity.

8. To differentiate liquor from increased
vaginal secretions, urine, or semen
Pool of liquor from posterior fornix
Nitrarizine test –may turn from yellow to
blue(96% accurate)
Ferning on glass slide (85% accurate)
If all three are positive-confirmatory
The absence of one indicates further testing

10. Biochemical measurement of high
volumes of glucose, fructose, prolactin,
alpha fetoproteins, and Diamine-oxidase,
foetal fibronectin in amniotic fluid.
Nile blue sulphate test-orange blue colour
of test.
If no free fluid is found, place dry perineal
pad
If PROM could still not be confirmed and
history is strongly suggestive-
amniocentesis and dye test (Evans blue)

12. Intra amniotic fluorescein:
Injection of 5% sodium fluorescein (1ml)
into amniotic cavity followed by
examination of tampon placed in
vagina by long wave ultraviolet light 1-2
hours later.
Amnioscopy:
Requires slight dilatation of cervix and may
cause rupture membrane.

13. Full blood count
Urinalysis and urine culture
Endocervical swab for M/C/S.
Blood film for malaria parasites
Electrolytes urea and creatinin.
Ultrasound scan-liquor volume, fetal
wellbeing.

14. Aim to deliver when extrauterine survival
is possible
And to prevent chorioamnionitis
Therefore management depends on GA
and presence or absence of amnionitis

15. Majority go into spontaneous labour
within 24 hours
Expectant management for 12-24 hours
is justified
No labour-carry out induction
Broad spectrum antibiotics.

16. Expectant management
Admit into the ward, and do
investigations
Broad spectrum antibiotics
4 hourly BP, pulse and temperature
Fetal kick chart
4 hourly fetal heart rate
Cardiotocogram twice weekly
Ultrasound scan twice weekly
Check state of liquor daily-sanitary
pads .

17. Extremely low fetal salvage rate
Very high risk of chorioamnionitis
Steroids, tocolytics and antibiotics have no
proven benefit
Management should be expectant or by
active termination.

18. Test for fetal lung maturity
Give corticosteroids for 24 hour
Deliver by induction of labour.

19. Fever
Maternal leukocytosis -daily WBC
Maternal tachycardia
(above100beats/m)
Fetal tachycardia
Uterine tenderness –check every 4
hours
Offensive liquor
treatment –deliver irrespective of GA
(Septicaemia, endotoxic shock and
DIC)
Broad spectrum antibiotics.

20. Proven to be beneficial at 24-33 weeks
Short course of not more than 24 hours
Reduced risk of respiratory distress
syndrome, necrotizing enterocolitis and
interventricular hemorrhage.

21. Controversial
Prophylactic tocolytics alone has not
been proven to improve outcome
Recommended for use for not more than
48 hours to facilitate administration of
corticosteroids and antibiotics.

22. Infection.
Hyaline membrane disease.
Pulmonary hypoplasia.
Abruptio placentae.
Foetal Distress.

23. THANK YOU