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PROM

Prepared by:

Dr. Gehanath Baral


MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
20th April, 2007

1
Definition:
• Spontaneous rupture of membrane after
28 weeks of pregnancy but before the
onset of labor.

• Preterm PROM Before 34 weeks

2
Causes
1. Increased friability of membrane:
– Inherent
– Infection
2. Decreased tensile strength of membrane
3. Increased intra-amniotic pressure:
– Polyhydramnios
– Multiple pregnancy
– Blow over the abdomen
4. Decreased holding capacity by Cx:
– Cx incompetence
– Uterine septum
– Hypoplastic uterus

3
Diagnosis
1. P/S exam
– PH= 6-6.2
– Vaginal=5+0.5; Liquor=7-7.5
– Litmus paper: yellow blue if PH>6

2. Ferning pattern

3. Fetal fat-containing cells stain


orange blue on Nile blue SO4

4. USG

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Test
1. Blood: TLC, DC

2. Urine: M/E, C/S

3. Vag. Fluid C/S

4. Phosphatidyl glycerol on vag. Fluid

5. BPP

6. NST

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Complication
1. Preterm labor and prematurity

2. Cord prolapse

3. Chorio-amnionitis

4. Anhydramnios:
– Dry labor
– Pulmonary hypoplasia
– RDS

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Management
1. Monitor temperature, pulse, FHR and start antibiotics

2. >37wks Wait for 24hrs Induction if no spont.labor

3. 34-37wks Wait for 24-48hrs Induction if no


spont.labor

4. <34wksWait & watch till 34-37wk

5. CS if induction fails or any complication