1. Premature Rupture of Membranes (PROM)

2. 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.

3. 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

4. INCIDENCE
10 % of all pregnancies

5. 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

6. 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

7. 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

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

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

12. 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

13. Thank you