ACOG PB139 Premature Rupture of
Membranes Questions with Complete
Solutions
How common is pulmonary hypoplasia after PROM before 24 weeks? 10-20%. Rarely
lethal with PROM subsequent to 23-24 weeks.
What fetal issues are associated with prolonged oligohydramnios? Potter-like facies (low
set ears, epicanthal folds) and limb contractures.
How to diagnose PPROM? History and Physical Exam for Pooling/Valsalva/Fern,
Amnisure, pH test. US for AFI. If still unclear, US guided transabdominal instillation of indigo
carmine dye.
Should digital cervical exam be performed? SVE only increases the risk of infection and
add little information available with speculum exam. Therefore they should be avoided unless
they appear in labor.
Initial managment of PROM Assess GA, fetal presentation and status. R/U infection,
abruptio placentae and fetal compromise. Collect GBS
, Management of PROM at term Start GBS prophylaxis if indicated and start induction
Prostiglandin is equally effctive as pitocin but has increased risk of infection. Infection also more
common with mechanical (foley) dilation
How long do you wait with adequate contractions before considering C Section? 12-18
hrs.
When is delivery of pre-term fetus recommended with PROM? NRFHT, Chorio, abrupio
placenta
How to manage Preterm PROM? <34 wks, Expectant managment up to 37w0d, Mercer
antibiotics, Corticosteroids (BMZ), MgSO4 for neuroprotection
PROM prior to viabiliy (24 wks)? Patient counseling, expectant managment vs induction,
MERCER antibiotics, GBS prophylaxis and Corticosteriods are not recommended prior to
viability. No tocolysis
Membranes Questions with Complete
Solutions
How common is pulmonary hypoplasia after PROM before 24 weeks? 10-20%. Rarely
lethal with PROM subsequent to 23-24 weeks.
What fetal issues are associated with prolonged oligohydramnios? Potter-like facies (low
set ears, epicanthal folds) and limb contractures.
How to diagnose PPROM? History and Physical Exam for Pooling/Valsalva/Fern,
Amnisure, pH test. US for AFI. If still unclear, US guided transabdominal instillation of indigo
carmine dye.
Should digital cervical exam be performed? SVE only increases the risk of infection and
add little information available with speculum exam. Therefore they should be avoided unless
they appear in labor.
Initial managment of PROM Assess GA, fetal presentation and status. R/U infection,
abruptio placentae and fetal compromise. Collect GBS
, Management of PROM at term Start GBS prophylaxis if indicated and start induction
Prostiglandin is equally effctive as pitocin but has increased risk of infection. Infection also more
common with mechanical (foley) dilation
How long do you wait with adequate contractions before considering C Section? 12-18
hrs.
When is delivery of pre-term fetus recommended with PROM? NRFHT, Chorio, abrupio
placenta
How to manage Preterm PROM? <34 wks, Expectant managment up to 37w0d, Mercer
antibiotics, Corticosteroids (BMZ), MgSO4 for neuroprotection
PROM prior to viabiliy (24 wks)? Patient counseling, expectant managment vs induction,
MERCER antibiotics, GBS prophylaxis and Corticosteriods are not recommended prior to
viability. No tocolysis
