1. PREMATURE RUPTURE OF MEMBRANES (PROM) Lin Qi De

2. Definition PROM is defined as the rupture of the chorioamniotic membrane before the onset of labor

3. Incidence  PROM occurs in about 10%~15% of all delivery  PROM is associated with 10% of term pregnancy

4. Cause of PROM  Trauma (abdominal striked intensely)  Sexual intercourse(particularly in the late gestational weeks)  Vaginal infection due to bacteria 、 virus 、 TOXO 、 CMV 、 HPV and HSV,et al  Smoking

5.  Other :  Prior PROM  A short cervical length  Prior preterm delivery  Bleeding in early pregancy

6. Affect of PROM on the mothers and infants Mothers: (1) Infection : intrauterine puerperal (2) Placental abruption (3) Preterm delivery

7. Infants: (1) Preterm Baby and their Complications : (RDS / Fetal and Neurologic dysfunction Intracranial hemorrhage) (2) neonatal pneumonia 、 sepsis (3) Pulmonary hypoplasia and fetal compression syndrone (4) Prolapse or compression of umbilical cord (5) Abruptio placenta

8. Clinical manifestation (1) Fluid passing through the vagina suddenly, and then small amounts of fluid flow through the vagina intermitently, particularly when the increased of abdorminal pressure (cough,sneeze,et al)

9. (2) Free flowing amniotic fluid (3) Fever / heart rate of mother and infants ↑ / WBC and CRP ↑ / Uterine tenderness on palpation

10. Diagnosis (1) Vaginal speculum exam.: leakage of amniotic fluid (2) PH determination of vaginal fluid (3) The “fern” test (4) Aminoscopy

11. Management PROM at term: (1) Awaiting the onset of spontaneous labor for 12-24h (2) Termination of pregnancy after 24 hours PROM before term: Termination of pregnancy (1) Evidence of fetal pulmonary maturation (2) Evidence of inturine infection

12. Expectant therapy Indication : (1) Evidence of fetal pulmonary inmaturation (2) Without evidence of inturine infection Management: (1)To enhance fetal pulmonary maturation (2) Antibiotic (3) Tocolysis