1. Pre-labor Rupture of Membranes (PROM)
Family Medicine Specialist CME
Vientiane, Lao PDR
December 10 – 12, 2008

2. Objectives
Define prelabor rupture of membranes (PROM) and discuss possible etiology
Discuss diagnosis of PROM
Discuss management of PROM

3. PROM (Pre-labour Rupture of Membranes)
Rupture of membranes at term (>37 weeks gestation)
Occurs
2-10% of pregnancies
Latent phase (time from rupture to labor)
90% will go into labor within 24 hours

4. PPROM (Preterm Prelabor Rupture of Membranes)
Rupture of the membranes before 37 completed weeks of gestation
Occurs:
2 – 3% of all pregnancies
Accounts for 1/3 of all preterm deliveries
Latent Phase – Time from rupture till labor
28 – 34 weeks gestation
50% go into labor within 24 hours
80 – 90% go into labor within 1 week

5. Etiology Idiopathic Infections Polyhydramnios
Multiple gestation (Twins)
Uterine abnormality
Cervical incompetence
Trauma (MVA, domestic violence)
Previous cervical surgery (Cone Biopsy)
Other (Smoker, stress, lifestyle, nutrition, drugs)

6. Complications of PROM Term Preterm Fetal / neonatal Maternal Neonatal
Infection
Cord compression / prolapse
Maternal
Increased induction rate
Increased cesarean section rate
Preterm
Neonatal
Infection
Cord compression / prolapse
Pulmonary hypoplasia & fetal deformation (ROM <24 weeks gestation)
Maternal
Increased cesarean section rate
Preterm labor & delivery

7. Diagnosis History Sterile speculum exam Amniotic fluid testing for
Ferning
Nitrazine (pH)

8. Management - any gestation
Confirm diagnosis
Assess maternal & fetal well-being
Determine fetal position
Assess cervical status with speculum exam (obtain fluid for cultures / testing)
Avoid digital examination until induction
Assess for conditions requiring immediate delivery
Infections
Conditions requiring concurrent management (eg. PIH)
Indications for immediate delivery

9. PROM (>37 weeks) Management
Avoid digital exam until induction of labor
Maternal and fetal well-being good
Assess and monitor expectantly up to 48 hours
Perform cesarean section if contraindications to vaginal delivery
Eg. Breech, Cord prolapse, placenta previa

10. PPROM (34 – 37 weeks) Management
Limited research
Consider transfer to hospital with NICU for delivery
Consider induction versus expectant management
Expectant care may have higher risk
Chorioamnionitis
Neonatal infections

11. PROM (<34 weeks) Management
Consider transfer to hospital with NICU
Consider Betamethasone treatment
Consider antibiotics to delay latent phase
Ampicillin / Erythromycin
Assess for infection / Chorioamnionitis
Treat & deliver if develops
Perform ultrasound
Determine fetal position, Amniotic fluid volume

12. Conclusion PROM at any gestation has many causes
Management of PROM is aimed at reducing both maternal & neonatal infections and complications