Pprom & prom

Pprom & prom

1. Preterm premature rupture of membrane (PPROM) & P remature rupture of membrane (PROM) By: Dr Ismah Haron 1

2. Definition PPROM: Amniotic membrane rupture before 37 completed weeks PROM: Amniotic membrane rupture at or after 37 completed weeks and not in labour yet 2

3. Its importance Associated with: Cord prolapse Maternal and neonatal infection 40 % of preterm deliveries 3

4. Diagnosis History Gushing of warm fluid, dribbling though thigh Examination Per abdomen: uterus smaller than date, easily felt fetus parts Per speculum: pooling of liquor at posterior fornix (color, smell) Cough test Others Ultrasound: oligohydramnios Special tests: litmus, ferning and nitrazine test 4

5. 5 ferning nitrazine litmus

6. Management HVS, FBC PPROM Antibiotic: erythromycin X10/7 Neonatal infection was significantly reduced in the babies whose mothers received antibiotics (RR 0.68; 95% CI 0.53–0.87). IM Dexamethasone 12 mg 12 hrs apart X1/7 Ventilator support Mode of delivery 6

7. PROM Clear liquor Allow labour, induced Meconium stained liquor  pitocin /EM LSCS IV Ampicillin 2 g stat & 1 g QID 7

8. Chorioamnionitis Maternal Pyrexia Tachycardia Leukocytosis Uterine tenderness Fetal Tachycardia 8

9. Management Delivery IV Cefuroxime & IV Metronidazole Inform pediatric team 9

10. References Preterm Prelabour Rupture of Membranes. November 2006 (Minor amendment October 2010). RCOG Green-top Guideline No. 44 Term Prelabour Rupture of Membranes (Term PROM ). C- Obs 36, 1st Endorsed: July 2010, Current: July 2010, Review: July 2013. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists A Practical Approach To Obstetric Problems 3 rd edition by Prof Kulenthran Arumugam 10

11. THANK YOU 11