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)
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)
