PPROM and preterm

labor pictorial
Eu Ming Yong.

Figure 1: Investigation of amniotic

fluid

Figure 2: Microscopic examination of

amniotic fluid
Positive Ferning of
crystalline pattern
of dried amniotic
fluid owning to its
sodium chloride
and protein
content

AmniSure: placental alphamacroglobulin-1 protein

Vertical Caesarean Section

At the earliest gestations and in the
presence of oligohydramnios, the
lower uterine segment is often poorly
formed. Vertical caesarean section is
usually necessary, and this procedure
carries up to 5% risk of uterine rupture
in the subsequent pregnancies, some
of which will occur antenatal.

PROM vs PPROM management

History of membrane rupture: Gush of fluids +/- uterine contraction
PROM (prelabour
rupture of
membrane)
diagnosed when >
37 weeks
Wait for spontaneous
delivery within 24
hours

Deliver the baby

otherwise Induction
of labor

PPROM diagnosed
when less than or
equal to 36 weeks
6/7 days

Management of PPROM
History of membrane rupture: Gush of fluids +/- uterine contraction
Examination and Investigations:
High vaginal swabs: guide antibiotics therapy; GBS needs vaginalrectal swabs
Sterile speculum examination: pool of fluids in the posterior fornix
of the vagina
Chorioamnioniti
AmniSure: detect presence of placenta-alpha-macroglobulin-1s
protein
Clinical findings
Nitrazine test: amniotic fluid is alkaline- turn it blue
and investigation
Microscopic: positive amniotic fluid- ferning effect
findings must
Cardiotogography: Monitor fetal heart rate (increase signs of
correlate !
chorioamnionitis)
Ultrasonography: amniotic fluid volume (oligohydramnios?)
FBC: raise in WBC, leukocytosis, raise in CRP
Every 4-8 hourly: monitor maternal BP, temperature, PR, and Fetal
heart rate

Admit the patient to general ward

Conservative management
1. Prophylactic antibiotics: Erythromycin
250mg QID for 10 days or until
women is in established labor
2. GBS status: if not known, a Rapid NAAT,
if positive then treat patient; if negative
but present of one of the following:
delivery before 37 weeks of gestation,
membrane rupture of more than 18
hours, temperature more than 38
degree, previous infant with GBS, or
evident of GBS bacteriuria during
pregnancy treatment with IV
ampicillin 2g IV STAT, then 1g IV
every 6 hours at least 48 hours
3. Corticosteroids: indicated when less
than 34 weeks of gestation
4. IV MgSO4: indicated when less than
32 weeks of gestation
5. Mode of delivery: unless the
ultrasound presentation shows a
breech presentation or any
obstetrics complication, a

At the earliest gestations and in the

presence of oligohydramnios, the
lower uterine segment is often
poorly formed. Vertical caesarean
section is usually necessary, and
this procedure carries up to 5%
risk of uterine rupture in the
subsequent pregnancies, some
of which will occur antenatal.

Before 34 weeks of
gestation, evidence
points towards
conservative
management.

After 34 weeks of
gestation, currently no
evidence emerge as to
when to deliver
the baby
Risk of chorioamnionitis
is
proportionate to the
gestational age in
established PPROM.
Furthermore, management
of conservative includes to
monitor for chorioamnionitis
complications