Premature Rupture of Membranes (PROM)

Definition Spontaneous rupture of the membranes any time beyond 28th week of pregnancy but before the onset of labour is called premature (pre labour) rupture of membranes.

TERM PROM When the rupture occurs beyond 37th week but before the onset of labour it is called term PROM PRE TERM PROM When the rupture occurs before the 37th completed weeks it is called preterm PROM PROLONGED RUPTURE OF MEMBRANE Rupture of membrane for 24 hours before delivery is called prolonged rupture of membrane

INCIDENCE 10 % of all pregnancies

Causes Increased friability of the membranes Decreased tensile strength of the membranes Polyhydramnios Cervical incompetence Multiple pregnancy Infection – Chorio-amnionitis, UTI, lower genital tract infections

Diagnosis Subjective symptom is Escape of watery discharge per vagina either as a gush or slow leak. Usually confused with Hydrorrhoea gravidarum Incontinence of urine

Confirmation of Diagnosis Speculum examination Examination of the collected fluid from posterior fornix for Detection of pH ( 6 – 6.2) Ferning pattern 0.1% Nile blue sulphate test – orange blue colouration of cells USG

Investigations Complete blood count Urine analysis and culture High vaginal swab for culture Vaginal pool to estimate phosphatidyl glycerol USG NST

Dangers Preterm labour and prematurity Ascending infection Cord prolapse Dry labour Fetal pulmonary hypoplasia R.D.S

Management - Assess gestational age and fetal weight - Patient not in labour - Absence of infection and fetal distress - biophysical profile and NST To monitor maternal pulse, temperature, FHS and start prophylactic antibiotics Pregnancy < 34 weeks Pregnancy > 34 weeks Pregnancy > 37 weeks Expectant management Wait for spontaneous onset Wait for spontaneousto continue for fetal maturity. of labour for 24 – 48 hours labour for 24 hours Transfer patient with “fetus in FAILS FAILS Utero” to equipped centre Induction of labour Induction of labour with oxytocin with oxytocin

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