Management for PROM

1. Establish the diagnosis by taking full and detailed history which was suggestive to
Preterm Rupture of Membrane (PROM)
2. Do thorough physical examinations which include vital signs to look for sign of
chorioamnionitis, abdominal examination to determine the size of uterus, lie,
presentation and clinical estimation of liquor volume. Digital vaginal examination can
be done since patient is already at term for bishop scoring and per speculum
examination to clinically demonstrate evidence of leaking liquor by presence of
pooling of fluid (liquor) and positive cough impulse.
3. 2 tests can be done to confirm presence of liquor which are
a. Litmus test
b. Nitrazine test
4. Managements are as follow
a. Discuss with specialist
b. Admit the patient for monitoring and subsequently delivery
c. Monitor maternal wellbeing which includes blood pressure, temperature, pulse
rate, respiratory rate, Spo2 and pain score.
d. Monitor for any signs and symptoms of chorioamnionitis. Signs of
chorioamnionitis includes maternal pyrexia, palpitation, abdominal tenderness,
foul smelling liquor and non-reactive CTG
e. Fetal surveillance includes 4 hourly fetal kick chart and CTG twice daily
f. Do strict pad charting 4 hourly. Record the colour and odour of fluid.
g. Start patient on IV Broad Spectrum Antibiotic (IV Ampicillin 1000mg 4
hourly) as prophylaxis or treatment if there is evidence of chorioamnionitis.
h. In gestational diabetes mellitus (GDM) patient, blood sugar profile should be
done to monitor sugar control. Start on insulin sliding scale if sugar level is
persistently high.
i. Discuss with patient regarding the mode and timing of delivery. The most
preferred mode of delivery is induction of labour if patient has no
contraindication to induction of labour for an instance abnormal fetal lie and
presentation or previous uterine scar. The timing of delivery is immediate
since it is already at term
j. For induction of labour, CTG should be reactive (not in fetal distress) and
maternal vital signs should be stable. Cervical assessment for Bishop scoring
 done before Prostin 3mg pessary given. Maternal vital signs and CTG should
be monitored. If CTG is not reassuring or maternal vital signs are not stable,
should inform specialist for further management
k. Review the Bishop score 6 hourly, if cervix is not favourable another prostin
should be given and keep on monitoring for signs of labour.
l. If the cervix is already favourable, send to labour room for delivery.