PRELABOUR RUPTURE OF MEMBRANES

DEPT.OBSTETRIC &GYNECOLOGY SIDIKALANG HOSPITAL

Introduction
PROM occurs before the onset of labor. Interval between rupture of the membranes and labor is generally taken as 1 hour. Maternal and neonatal outcomes are poor in preterm PROM. Current management options include the administration of antibiotic, corticosteroids and tocolytics drugs.

Incidence
2 to 18% of all pregnancies. Preterm PROM : 0,7 to 4% 0f pregnancies. Preterm PROM accounts for 20 to 40% of PROM cases.

Diagnosis
Visualization of amniotic fluid in the posterior vaginal fornix or amniotic fluid passing from cervical canal. PH test Fern test Nile blue test USG : oligohydramnious Instillation of indigocarmine dye

Differential diagnoses
Urinary leakage Excess vaginal discharge with advanced dilatation or membrane prolaps Cervicitis Bloody show Semen Vaginal douches

PRETERM PROM
Risk for preterm PROM :
intrauterine infection reproductive tract infection prior preterm delivery vaginal bleeding cervical cerclage cervical incompetence uterine distention (multiple pregnancy,hydramnios) cigarette smoking Nutritional status low socio-economic

Maternal complication associated with PROM

Complication

PROM range (%)

Chorioamnionitis 10 40

Preterm PROM range (%) 13 - 60 2 - 13 4 -12

Metritis Abruption

10 30 48

Fetal complications associated with preterm PROM delivery prior to 34 gestational week
Complication 26 weeks IVH (grade 3 or 4) RDS NEC Sepsis PDA Neonatal death rate 29,6 92,6 11.1 33.3 48.1 45.3 30 weeks 1,9 54.7 15.1 11,3 22.6 9.4 34 weeks 0 13.5 3.1 3.5 1.7 1.3

Maternal consequences
Chorioamnionitis Metritis Placental abruotion Sepsis Cesarean section Maternal death