ACOG PB139 Premature Rupture Of Membranes:
Questions With Expert Solutions
How common is preterm deliver in the USA? Right Ans - 12% of all births
How common is PROM? Right Ans - 3%
What is the main issue with management of PROM? Right Ans -
Prematurity vs Risk of Expectant Management (Infection, Abruption,
Umbilical cord accident)
Definition of PROM Right Ans - Rupture of membranes before the onset of
labor
Definition of PPROM Right Ans - Membrane rupture before labor and
before 37 weeks of gestation
What causes rupture of membranes? Right Ans - Normal weakening of
membranes, shearing forces from uterine contractions.
Risk factors for PROM? Right Ans - Intraamniotic infection, hx of PROM,
Shortened cervix, 2nd/3rd trimester bleed, low BMI, low SES, Cigarette
smoking, illicit drug use
How often is PROM in term pregnancies? Right Ans - 8%. Generally
followed by onset of labor.
Consequence of term PROM? Right Ans - Intrauterine infection, increases
with duration of membrane rupture
How many patients deliver regardless of obstetric managment of PPROM?
How many between 2-5 weeks? Right Ans - 50%, 70-80%
Latency after membrane rupture is _____ correlated with GA at time of PPROM.
Right Ans - Inversely
Clinically evident intraamniotic infection occurs in ____. Post partum infection
occurs in _____. Incidence of infection is higher at _______. Right Ans - 15-25%
, 15-20%
Earlier GA
Placental abruption occurs in ____ of PPROM. Right Ans - 2-5%
Most common issues/risks of prematurity? Right Ans - Respiratory distress
- most common
Sepsis
Intraventricular hemorrhage
Necrotizing Enterocolitis
PPROM w/ intrauterine inflammation has increased risk of what comorbidity?
Right Ans - Neurodevelopmental impairment. Early GA associated with
increased risk of neonatal white matter damage.
How often does PROM occur prior to viability? Right Ans - 1%
Maternal complications from previable PROM? Right Ans - Intraamniotic
infection, endometritis, abruptio placentae, retained placenta. Sepsis occurs
1% of time.
How common is pulmonary hypoplasia after PROM before 24 weeks? Right
Ans - 10-20%. Rarely lethal with PROM subsequent to 23-24 weeks.
What fetal issues are associated with prolonged oligohydramnios? Right
Ans - Potter-like facies (low set ears, epicanthal folds) and limb contractures.
How to diagnose PPROM? Right Ans - 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? Right Ans - 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 Right Ans - Assess GA, fetal presentation and
status. R/U infection, abruptio placentae and fetal compromise. Collect GBS
Questions With Expert Solutions
How common is preterm deliver in the USA? Right Ans - 12% of all births
How common is PROM? Right Ans - 3%
What is the main issue with management of PROM? Right Ans -
Prematurity vs Risk of Expectant Management (Infection, Abruption,
Umbilical cord accident)
Definition of PROM Right Ans - Rupture of membranes before the onset of
labor
Definition of PPROM Right Ans - Membrane rupture before labor and
before 37 weeks of gestation
What causes rupture of membranes? Right Ans - Normal weakening of
membranes, shearing forces from uterine contractions.
Risk factors for PROM? Right Ans - Intraamniotic infection, hx of PROM,
Shortened cervix, 2nd/3rd trimester bleed, low BMI, low SES, Cigarette
smoking, illicit drug use
How often is PROM in term pregnancies? Right Ans - 8%. Generally
followed by onset of labor.
Consequence of term PROM? Right Ans - Intrauterine infection, increases
with duration of membrane rupture
How many patients deliver regardless of obstetric managment of PPROM?
How many between 2-5 weeks? Right Ans - 50%, 70-80%
Latency after membrane rupture is _____ correlated with GA at time of PPROM.
Right Ans - Inversely
Clinically evident intraamniotic infection occurs in ____. Post partum infection
occurs in _____. Incidence of infection is higher at _______. Right Ans - 15-25%
, 15-20%
Earlier GA
Placental abruption occurs in ____ of PPROM. Right Ans - 2-5%
Most common issues/risks of prematurity? Right Ans - Respiratory distress
- most common
Sepsis
Intraventricular hemorrhage
Necrotizing Enterocolitis
PPROM w/ intrauterine inflammation has increased risk of what comorbidity?
Right Ans - Neurodevelopmental impairment. Early GA associated with
increased risk of neonatal white matter damage.
How often does PROM occur prior to viability? Right Ans - 1%
Maternal complications from previable PROM? Right Ans - Intraamniotic
infection, endometritis, abruptio placentae, retained placenta. Sepsis occurs
1% of time.
How common is pulmonary hypoplasia after PROM before 24 weeks? Right
Ans - 10-20%. Rarely lethal with PROM subsequent to 23-24 weeks.
What fetal issues are associated with prolonged oligohydramnios? Right
Ans - Potter-like facies (low set ears, epicanthal folds) and limb contractures.
How to diagnose PPROM? Right Ans - 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? Right Ans - 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 Right Ans - Assess GA, fetal presentation and
status. R/U infection, abruptio placentae and fetal compromise. Collect GBS
