Preterm rupture

of foetal
membranes
Presented by Dr Ikobho E.H
SENIOR REGISTRAR
Dept. of Obstetrics and
Gynaecology.
UPTH
 INTRODUTION

 Very common problem in our

environment
 May occur at any time during
pregnancy
 High risk of foetal wastage
 Leads to preterm labour and
prematurity
 High perinatal mortality and
morbidity
 Definition

 Premature rupture of membranes is

-rupture of membranes before the
onset of labour
 Preterm rupture of membranes refers
to rupture of membranes before 37
completed weeks of gestation
 Pre labour rupture of membranes
 Preterm prelabour rupture of
membranes
 Incidence

 Occur in about 10.7% of all

pregnancies
 In 94% of the cases the foetus is
mature
 Premature fetuses (1000-2500g)
account for about 5% of cases
 While in about 0.5% of cases, the
foetus is immature (less than 1000g)
 4.4% in UPTH from 2004 annual
report
 Socio-demographic risk
factors
 Exact cause is unknown
 Teenage pregnancy and women
above 35
 Low social class
 Malnutrition (BMI of less than 19)
 Single women (unmarried and
 unsupported)
 Smokers
 family history of PROM and pre term
birth
 Medical factors
 Anaemia
 Polycythaemia
 Systemic infections-malaria, UTI
 Cardiac disease
 chronic renal disease
 Obstetric factors
 Cervical incompetence
 Polyhydramnios
 Multiple gestation
 Vaginal infections
 Intrauterine infections-TORCH
 Previous history of PROM
 Abnormal lie and presentation
 pathology
 Preterm labour and prematurity
 Cord prolapse
 Abruptio placenta
 Chorioamnionitis
 Intrauterine infections
 Pulmonary hypoplasia
 Fetal limb position defects
 Increased risk of perinatal mortality
 History

 Sudden gush of fluid per vaginam

 Continuous leakage
 duration
 Lower abdominal pain
 Vaginal bleeding
 Any predisposing factor
 Any complication
 treatment
 Clinical examination
 General examination
 Systemic examination (including
uterine content)
 Avoid or minimal vaginal
examination
 Speculum examination
 Sterile speculum
examination
 Necessary to confirm drainage
 Gush of liquor from cervical os
 Cervical effacement and dilatation
 Cord prolapse
 Mechonium stained liquor
 Offensive
 Collect liquor for fetal lung maturity
 Other confirmatory test

 To differentiate liquor from increased

vaginal secretions, urine, or semen
 Pool of liquor from posterior fornix
 Nitrarizine test –may turn from
yellow to blue(96% accurate)
 Ferning on glass slide (85% accurate)
 If all three are positive-confirmatory
 The absence of one indicates further
 Other measures
 Biochemical measurement of high
volumes of glucose, fructose,
prolactin,alpha fetoproteins, and hcG
in amniotic fluid
 If no free fluid is found, place dry
perineal pad
 If PROM could still not be confirmed
and history is strongly suggestive-
amniocentesis and dye test (Evans
blue)
 Other investigations
 Full blood count
 Urinalysis and urine culture
 Endocervical swab for M/C/S
 Blood film for malaria parasites
 Electrolytes urea and creatinin
 Ultrasound scan-liquor volume, fetal
wellbeing,
 Treatment
 Aim to deliver when extrauterine
survival is possible
 And to prevent chorioamnionitis
 Therefore management depends on
GA and presence or absence of
amnionitis
 Term pregnancy with
PROM
 Majority go into spontaneous labour
within 24 hours
 Expectant management for 12-24
hours is justified
 No labour-carry out induction
 Broad spectrum antibiotics
 Preterm PROM without
amnionitis 24-32 weeks
gestation
 Expectant management
 Admit into the ward, and do investigations
 Broad spectrum antibiotics
 4 hourly BP, pulse and temperature
 Fetal kick chart
 4 hourly fetal heart rate
 Cardiotocogram twice weekly
 Ultrasound scan twice weekly
 Check state of liquor daily-sanitary pads
 Prom at less than24
weeks
 Extremely low fetal salvage rate
 Very high risk of chorioamnionitis
 Steroids, tocolytics and antibiotics
have no proven benefit
 Management should be expectant or
by active termination
 PROM between 32 and 34
weeks and no amnionitis
 Test for fetal lung maturity
 Give corticosteroids for 24 hour
 Deliver by induction of labour
 Prom with amnionitis
 Fever
 Maternal leukocytosis -daily WBC
 Maternal tachycardia (above100beats/m)
 Fetal tachycardia
 Uterine tenderness –check every 4 hours
 Offensive liquor
 treatment –deliver irrespective of GA
(Septicaemia, endotoxic shock and DIC)
 Broad spectrum antibiotics
 Role corticosteroids
 Proven to be beneficial at 24-33
weeks
 Short course of not more than 24
hours
 Reduced risk of respiratory distress
syndrome, necrotizing enterocolitis
and interventricular hemorrhage
 Role of tocolytics
 Controversial
 Prophylactic tocolytics alone has not
been proven to improve outcome
 Recommended for use for not more
than 48 hours to facilitate
administration of corticosteroids and
antibiotics
Conclusion
Thank you