PROM

5. PROM is defined as the rupture of the
chorion & amniotic sac more than one
hour before the onset of labor(uterine
contractions).
uterine contractions of sufficient
frequency and intensity to result in
progressive effacement and dilation of
the cervix
 PROM is considered prolonged when it occurs
more than 18 or 24 hours before labor.

6. PROM is considered preterm when it
occurs before 37 weeks gestation, and is
called Preterm Premature Rupture of
Membranes (or PPROM)
Latent phase :
 the period between rupture of membranes
and beginning of uterine contractions

7. 5-10 % of all term pregnancy PROM.
PPROM in 1% of all pregnancies
PROM is accelerator of 1/3 of preterm
pregnancies
In pt with history of PROM the incidence of
recurrence is 32%

8. Idiopahtic
Infection
Over distention (Multiple preg,
Polyhydramnios)
Antepartum Haemorrhage & abruption
Intercurrent illness
Cervical weakness

9.  Bacterial infection, (Genital tract infection)
 Smoking, Drugs abuse (cocaine)
 Antepartum bleeding
 Anatomic defect in the structure of the amniotic sac,
uterus, or cervix
 Multiple pregnancy
 Acute Inflammation of Placenta
 Maternal risk factors
 Chorioamnionitis or sepsis
 Emotional states of fear and pre labor rupture of
membranes at term
 Fetal factors
 prematurity, infection, cord prolapsed ,mal presentation
or genetic mutations.

10. Two are different causes, different
management, and different outcomes—
PROM is a variation of normal,
whereas PPROM is caused by
subclinical infection and is dangerous.
The outcome is dependent on the
gestational age,

12. Differential diagnosis —
Urinary Tract Infection
Urinary incontinence,
 Vaginal discharge, and perspiration.
 Placental Abruption
Constipation
Renal agenesis,
Obstructive uropathy,
Utero-placental insufficiency
Reductions in amniotic fluid volume
Gastroenteritis

15. Infection:
Increase Pulse & temperature & a
flushed appearance abdominal
examination may reveal a Clinical
suspicion of oligohydramnios or
uterine tenderness if
chorioamnionitis is present

19. •Maternal Steriod:
Single course (two Inj 12-24 hours or 12mg I.M ,
6mg/12hrsx4 doses) given between 24 & 34wks
gestation & received within 7 days of delivery
result improved neonatal outcomes Reduction in
RDS in neonatal.
Max benefit seen after 48 hrs or more than 7
days before delivery lead to benefit below 28
wks.

20. 50% contraction cease spontaneously
Delay preterm labour would improve fetal
outcome without causing harm to mother or
fetus
Almost no clinical benefit & only nifedipine may
improve fetal outcome
Nifedipine 20mg PO then 10-20mg/6-8h PO
according to uterine activity

21. 10 days course of Erythromycin
Iv AB (eg ampicillin 500mg/6h iv + Gentamicin
3-5mg/kg/8hrs) 5-7 days

23. Gestational age over 36 weeks
A. In absence of infection, fetal distress
and abnormal lie, wait for 24 hours as
about 90% of patients with PROM will
pass into spontaneous labor. Prophylactic
antibiotic can be given during this period.
B. PGE2 and / or oxytocin is used for
induction of labor in patients did not pass
into labor after 24 hours.
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24.  Gestational age between 34-36 weeks
A. In absence of infection and fetal distress,
wait for 48 hours as rupture of membrane
itself will accelerates lung surfactant
production and hence lung maturity.
B. Induce labor after 48 hours with PGE2 and
/or oxytocins.
C. Prophylactic antibiotics are given during this
period.
D. Caesarean section is indicated in breech
presentation < 36 weeks’ gestation.
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25. Gestational age between 28-34 weeks
In absence of infection, the main aim is to
manage the case conservatively till the
35th week when lung maturity mostly
occurs and the baby can survive.
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26. a. Rest in bed as long as there is escape of liquor with restriction
of efforts later on particularly those that increase intra-
abdominal pressure.
b. Temperature is recorded every 4 hours.
c. Observation for malaise, abdominal pain, uterine tenderness
and amount of escaped liquor on sterile vulval pads.
d. Leucocytic count and C-reactive protein may be done every
other day.
e. Prophylactic antibiotics may be given although this is not
advised by some authors as it may lead to colonisation of
resistant strains of organisms in the genital tract.
f .Tocolytic drugs: are given if uterine activity starts.
g .Corticosteroid therapy: is given for 48 hours if labor was
imminent or will be induced before 35 weeks.
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27. Gestational age less than 28 weeks
There is little chance of fetal survival and the
condition is usually considered as
inevitable abortion.
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