Summary Premature Rupture of Membranes

PROM (premature rupture of membranes)
ROM = Rupture of membranes
PROM = ROM >1hr before the onset of labour
PPROM (preterm PROM) = PROM before 37 weeks
Term PROM = PROM afer 37 weeks
Prolonged PROM = PROM lasting >24hrs, associate with increase risk of intra-amniotic infection

Aetiology i
 Cervical insufciency (Rx = cervical cerclage)
 Infecton – UTI, STI, or intra-amniotic Infection
 Multple pregnancy
 Vaginal bleeding (e.g. abruption)
 Polyhydramnios
 Amniocentesis
 Smoking during pregnancy
 Chronic steroid use
 CTDs
 Anaemia
 Low socioeconomic status
 Prior PROM
NOT associated with: Coitus, VE, Exercise, and Parity

Pathophysiology i
 Near term, a focal weakness evelops in the foetal membranes over the internal os which pre isposes to
rupture at this site

Complicatioos i
 Neonatal
- Prematurity
- Sepsis
- Pulmonary hypoplasia
- RDS (respiratory istress syn rome)
- IVH (intraventricular haemorrhage)
- NEC (necrotising enterocolitis)
- Skeletal eformities
- Perinatal mortality (x4)
 Maternal
- Intra-amniotc infecton (30%)
- Nee for C-section elivery ( ue to malpresentation or cor prolapse)
- Post-partum en ometritis

Preseotatioo i
 Gush or trickle of vaginal fui
 DDX - Urinary leakage, Vaginal ischarge

Diagoosis
 Examination
- Avoi VE as promotes ascen ing intramniotic infection
- Speculum exam (STERILE) – 3 iagnostic criteriaa
o Pool of vaginal fuid
o Fluid turns pH/nitrazine paper blue (amniotic fui pH 7.4. Vaginal fui pH 4.5)
o Microscopic ‘ferning’ of vaginal fuid (i.e. fui crystallises on rying)