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PRESENTED BY :
B I PA S H A D A S
PREPARED BY
M . S C ( N ) 3 R DBIPASHA DAS
SEMEST E R (N) 3rd SEMESTER
M.SC
ROLL NO : 01
TRIPURACOLLEGE OF NURSING
INTRODUCTION OF
THE TOPIC
Rupture of the membranes near the end of pregnancy
(term) may be caused by a natural weakening of the
membranes or from the force of contractions. PORM is
a pregnancy complication. Rupture of fetal membranes
prior to labour in pregnancies between 28 - 37 weeks.
Rupture of membranes for more than 24hrs before
delivery is called prolonged rupture of membranes.
DEFINITION OF PROM:
Spontaneous rupture of membranes anytime
beyond 28wks of pregnancy but before the onset
of labour is called pre-labour rupture of the
membranes (PROM). PROM occurs in
approximately 10% of all .
pregnancies.
 CLASSIFICATION OF
PROM

1) Term PORM.

2) Preterm PROM.
RISK FACTORS OF PROM:
1. Infection like- STD.
2. Previous preterm delivery (PPROM)
3. 1st, 2nd, 3rd, or multiple trimester bleeding.
4. Multiple pregnancies.
5. Chorioamnionitis.
6. Vaginal infections.
7. Cervical abnormalities.
8. Abruptio plancenta .
9. Smoking & drug abuse like heroin.
10.Polyhydramnios due to membrane distension.
11.Acquired or congenital connective tissue disorder.
12.Nutritional deficiencies (Vitamin-C, copper, zinc).
 CAUSES OF PROM:
In majority, the causes are not known.
1) Increased friability of the membranes.
2) Decreased tensile strength of the membranes.
3) Polyhydramnios.
4) Cervical incompetence,
5) Multiple pregnancy.
6) Cervical length <2.5cm,
7) Previous preterm birth.
8) Low BMI ,Low socioeconomic conditions.
9) STIs such as chlamydia & gonorrhea.
10) Vaginal bleeding ,Cigarette smoking during pregnancy.
11) During pregnancy Infection-Chorioamnionitis, UTIs
and lower genital tract infection.
SYMPTOMS AND SIGNS:
 Vaginal discharge
 Gush of fluid
 Leaking of fluid
 Oligo/ Anhydramnios
 Cramping
 Contractions
 Back pain
HISTORY & PHYSICAL
EXAMINATION
 HISTORY:
1) “Gush” of fluid
2) Steady leakage of small amounts of fluid
 PHYSICAL EXAMINATION
1) Sterile vaginal speculum.
2) Assess cervical dilation and length.
3) Obtain cervical cultures.
4) Obtain amniotic fluid samples.
 FINDINGS
1) Pooling of amniotic fluid in posterior vaginal
fornix
2) Fluid per cervical os.
 
DIAGNOSIS:-
1. Watery discharge per vaginam.
2. Hydrorrhoea gravidarum.
3. Incontinence of urine specially in the later months.
4. Sterile Speculum exam (Pooling).
5. Nitrazine paper testing.
6. Fern test.
7. Fetal Fibronectin.
8. Ultrasonography.
9. Transabdominal Injection of Dye (Amniocentesis).
INVESTIGATIONS:-
1) Full blood count
2) Urine for routine analysis and culture.
3) High vaginal swab for culture.
4) Vaginal pool for estimation of phosphatidyl
glycerol and L:S ratio.
5) Usg for fetal biophysical profile.
6) Cardiotocography for NST.
DANGERS OF PROM:-
 The implications are less serious when the
rupture occurs near term than earlier in
pregnancy .
 In term PROM labour starts in 80-90% of cases
within 24 hours.
 Preterm labour and prematurity.
 Chance of ascending infection is more if labour.
 Cord prolapse.
 Continuous escape of liquor, dry labour.
 Placental abruption.
 Fetal pulmonary hypoplasia associated with
oligohydramnios.
 Neonatal sepsis, RDS & NEC in PPROM.
 Perinatal morbidities are high.
MANAGEMENT OF PROM:
Preliminaries: Aseptic examination with a sterile
speculum. Patient is put to bed rest and sterile vulval
pad is applied to observe any further leakage. Once the
diagnosis is confirmed, management depends on the
following factors:
1. Gestational age of the fetus.
2. Whether the patient is in labour or not.
3. Availability of NICU.
4. Fetal presentation &FHR pattern.
5. Active distress (maternal/fetal), Cervical assessment.
6. Any evidence of sepsis, Assess the mother condition.
7. Assess for infection, Exclude occult cord prolapse.
DELIVERY INDICATION
 Maternal-Fetal Distress.
 Infection.
 Abruption.
 Cord Prolapse.
EXPECTANT MANAGEMENT : PPROM
(<34 WKS.GESTATIONAL AGE)
 Bed rest
 Steroids for lung maturity
 Deliver at 34 wks
 Unless documented fetal lung maturity
 GBS prophylaxis
 Antibiotics
 No consensus, some experts recommend.
 
 EXPECTANT MANAGEMENT: PROM
(≥34 to ≤37 WKS GESTATIONAL AGE)
 Bed rest
 Steroids for lung maturity
 Tocolytic if indicated for lung maturity
 Antibiotics.
 Induction of labor
 GBS prophylaxis
 Fetal Surveillance
 Majority Inpatient Observation
 Assess for Chorioamnionitis.
 Some expectantly manage patients until 37weeks
gestation in the absence of delivery indication.
 No consensus
 MANAGEMENT:PROM
(> 37WK. GESTATION)
 Antibiotics
 Prolong latency period
 Prophylaxis of GBS in neonate
 Prevention of maternal chorioamnionitis and
neonatal sepsis
 Corticosteroids, Enhance fetal lung maturity
 Decrease risk of RDS, IVH, and necrotizing
enterocolitis
 Tocolytics
 Delay delivery to allow administration of
corticosteroids
 Controversial, randomized trials have shown no
pregnancy prolongation
MEDICAL MANAGEMENT:
 ANTIBIOTICS
1) Ampicillin 2gm/ IV/ 6 hrly/ for 2 days.
2) Amoxicillin 500 mg/ orally/ TDS/ 5 days.
3) Azithromycin 1gm/ orally/OD.
4) Erythromycin 250mg/ TDS for 5 days.
 CORTICOSTEROIDS
1) Betamethasone 12 mg/ IM/ OD for 2 days.
2) Dexamethasone 6 mg/ IM/ BD for 2 days.
 TOCOLYTICS
1) Nifedipine 10 mg/ orally/ after every 20min 3
times, then 6 hrly for 2 days.
 RISK-BENEFIT EXPECTANT
MANAGEMENT:
 RISKS-
1) Abruption
2) Chorioamnionitis
3) Cord Prolapse
4) Pulmonary Hypoplasia (<19 weeks PPROM)
5) Skeletal Deformities
6) Endometritis (1/3)

 BENEFITS-
1) Mature lung profile
2) Advancing GA (reducing risks associated with
PTB)
COMPLICATION OF PROM:-
 Maternal complications-
 Chorioamnionitis Preterm labour & delivery.
 Cord prolapse if malpresentation present.
 Infection.
 Dry labour (oligohydramnios).
 Increased caesarean-section rate.
 
COMPLICATION OF PROM:-
 Fetal complications-
 Pulmonary hypoplasia
 Skeletal malformations
 Infection.
 IUGR.
 IUFD
“CURRENT REVIEW OF LITERATURE”
Roy.R.et.al.(2020),Conducted a study on Management of Premature
Rupture of Membranes (PROM).The aim of the study was to observe
the patients during labor and compare the latent period, duration of
first stage of labor, modes of deliveries and the use of oxytocin and its
outcome in PROM cases with controls. Materials and methods: In this
study, A cohort study was conducted in the Dept. of Obs & Gynae of
KPL Medical College & Hospital, Kolkata on 100 cases of PROM and
100 cases of comparison group, over a period of one year. Results: It
was observed that onset of labor was more rapid with increasing
gestational age, use of oxytocin for induction & augmentation of labor
& operative deliveries were higher in PROM cases. Conclusion:
Individualized management of PROM cases depending on the
gestational age and risk of complications is the best way to achieve a
good feto-maternal outcome.
 SUMMARY
Preterm Premature rupture of membranes known when
rupture of membranes occurs before 37weeks and
beyond 37weeks, but before the onset of labour. Rupture
of membranes for>24hrs before delivery is called
prolonged rupture of membranes. About 8% to10% of
all pregnancies are complicated by PROM. PROM is an
important risk factor for prematurity. There are a
number of risk factors, associated with PROM, including
cigarette smoking, antepartum bleeding, multiple
gestation and polyhidramnios.
 CONCLUSION
When premature rupture of membranes is suspected, it
must be confirmed or ruled out. When it is diagnosed, by
proper treatment must be correct. Management of
PROM is aimed at reducing both maternal and neonatal
infection and complication. Midwives have an important
role to play when women experience pathological
problems in their pregnancy. Midwife updating of
professional knowledge and skills in all areas of practice
to ensure that every woman receives optimal maternity
care throughout her pregnancy.
BIBLIOGRAPHY:-
1) D.C Dutta’s, “ Textbook of Obstetrics”, 7th ed. 2013, New
Central Book Agency ( P) Ltd, London, page no:- 260- 268.
2) J.B Sharma,Midwifery & gynaecological nursing,1st ed , Avichal
publishing company ,new delhi.page no -275-287.
3) A.K Majhi, “ Bedside clinics in obstetrics” 3rd ed. 2015,Bimal
Kumar Dhur of Academic publishers, pvt.Ltd. Kolkata. Page no-
221-238.
4) Annamma Jacob, “ A Comprehensive textbook of midwifery &
gynaecological nursing”, 3rd ed. 2012, Jaypee Brothers Medical
Publishers (P) Ltd., page no:323-330.
5) Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 94-98.
6) https://www.slideshare.net/DivyaJain299/premature-repture-of-m
embranes-83728117
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7) https://www.slideshare.net/patelkrupapares/premature-rupture-of-
membrene
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