PRELABOR RUPTURE OF

MEMBRANES(PROM)

BY- ADITI GROVER

ROLL NO. -3
 DEFINITION
• Spontaneous rupture of membranes any time
beyond 28th week of pregnancy but before the
onset of labor is called prelabor rupture of
membranes(PROM)
• TERM PROM: When rupture of membranes occur
beyond 37th week but before the onset of labor, it
is called term PROM
• PREERM PROM: When rupture occurs before 37
completed weeks, it is called preterm PROM
• PROLONGED RUPTURE OF MEMBRANES: Rupture
of membranes for >24 hrs before delivery
 CAUSES
• Increased friability of membranes
• Decreased tensile strength of the membranes
• Polyhydroamnios
• Cervical incompetence
• Multiple pregnancy
• Infection-Chorioamnionitis, UTI, lower genital
tract infection
• Cervical length <2.5cm
• Prior preterm labor
• Low BMI (<19 kg/m2)
 DIAGNOSIS
• The only subjective symptom is escape of
watery discharge per vaginum either in the
form of gush or slow leak
**DIFFERENTIAL DIAGNOSIS:
• Hydrorrhea gravidarum
• Incontinence of urine
 CONFIRMATION
(1) Speculum examination – done taking aseptic precautions to
inspect liquor escaping out through the cervix
(2) To examine the collected fluid from posterior fornix(vaginal
pool) for:
(A) Detection of pH by litmus or Nitrazine paper. The pH
becomes 6-6.2. Nitrazine paper turns from yellow to blue at pH
more than 6
(B) To note the characteristic ferning pattern when a smeared
slide is examined under microscope.
(C) Centrifuged cells stained with 0.1% Nile blue sulfate showing
orange blue coloration of the cells
(3) AmniSure
(4) Ultrasonography
*Digital vaginal examination should be avoided
 INVESTIGATIONS
• Full blood count
• CRP
• Urine for routine examination and culture
• High vaginal swab
• Vaginal pool for examination of phosphatidyl
glycerol
• Ultrasonography
 DANGERS
• Preterm labor and prematurity
• Chance of ascending infection is more
• Cord prolapse
• Continuous escape of liquor for long duration may lead
to dry labor
• Placental abruption
• Fetal pulmonary hypoplasia
• Neonatal sepsis
• Perinatal morbidities
** Maternal complications of PROM:
• Chorioamnionitis, Placental abruption, Retained
placenta, endometritis, maternal sepsis and even death
 MANAGEMENT
• TERM PROM: If the patient is not in labor and
there is no evidence of infection or fetal distress,
she is observed carefully in hospital. Generally in
90% cases spontaneous labor ensues within 24
hrs. If labor doesnot start induction of labor with
oxytocin is commenced. Cessarean section is
performed with obstetric indications
• PRETERM PROM: Ideally the patient should be
transferred with the fetus in utero to an unit able
to manage preterm neonates effectively
• If gestational age is 34 weeks or more,
perinatal mortality from prematurity is less.
Labor generally starts spontaneously within 48
hrs, otherwise induction with oxytocin is
instituted
• When gestational age is less than 34 weeks,
conservative attitude generally followed in
absence of any maternal or fetal indications
 USE OF ANTIBIOTICS
• Prophylactic antibiotics are given to minimize
maternal and perinatal risk of infection.
Intravenous ampicillin, amoxicillin, or
erythromycin for 48 hours followed by oral
therapy for 5 days or until delivery is
recommended. Pelvic rest and antibiotics help
to seal the leak spontaneously and reduce
infection
USE OF CORTICOSTEROIDS
• To stimulate surfactant synthesis against RDS
in preterm neonates is advised
THANK YOU