National University of Rwanda Family and Community Medicine

PREMATURE RUPTURE OF MEMBRANES (PROM)
KABERA René, MD Resident PGY II- Family and Community Medicine Obs-Gyn. Dept Ruhengeri Hospital Feb 2010.

ESSENTIALS OF DIAGNOSIS
1. History of a gush of fluid from the vagina or watery vaginal discharge.

2. Demonstration of amniotic fluid leakage from the cervix. 3. ≥1h before the onset of labor.

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General Considerations
1. Rupture of the membranes may happen at any time during pregnancy. 2. It becomes a problem if the fetus is preterm (preterm) . 3. >24 Hrs, prolonged premature rupture of membranes -time between rupture of the membranes and the onset of labor is.

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General considerations c’t
1.    1. 2. Causes Infections . Cervix incompetency. Hydramnios … 10.7 % in all pregnancy. 94% mature fetus (>2500 grs) ,5% premature fetus (1000-2500 grs),immature fetus 0.5%(<1000 grs).
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Pathophysiology
1. PROM is an important cause of preterm labor, prolapse of the cord, placental abruption, and intrauterine infection. 2. In extremely prolonged PROM, the fetus may have an appearance similar to that of Potter's syndrome (eg, extraordinary flexion, wrinkling of the skin). 3. If PROM occurs at less than 26 weeks' EGA, it can cause pulmonary hypoplasia and limb positioning defects in the newborn.
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Clinical findings
1. Symptoms 2. The patient usually reports a sudden gush of fluid or continued leakage. 3. Reduced size of the uterus, and increased prominence of the fetus to palpation. 4. Sterile Speculum Examination 5. Pooling , Nitrazine test, Ferning.
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Lab test
1. CBC , CRP, U/S, Amniocentesis for lung maturation 2. Amniotitis : most common germ is streptococci B-fever ,leukocytosis (>16000 WBC),uterine tenderness, tachycardia ( >100 btm-mother,>160 btmfetus ),foul smelling amniotic liquid .

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Management
1. A.Amniotitis : delivery regardless of gestational age. Broadspectrum antibiotics should be started. if no labor , labor should be induced to expedite delivery. 1. B. Term Pregnancy Without Amnionitis: 2. Nonintervention is an acceptable initial course of treatment, but if the patient does not go into labor within 6-12 hours after PROM, labor should be induced to minimize
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Management c’t
1. C. Preterm Pregnancy Without Amnionitis Pregnancies beyond 33-34 weeks' EGA can be managed as a term pregnancy because there is no evidence that antibiotics, corticosteroids, or tocolytics improve outcome in these patients. 1. Pregnancies prior to 24 weeks' EGA with PROM have extremely low rates of fetal salvage with considerable maternal risk. Furthermore, at this early gestational age, steroids, tocolytics, and antibiotics have no proven benefit.
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Management c’t
1. For pregnancies with PROM between 24 and 32 weeks' EGA. 2. Antibiotics. 3. Corticosteroids. 4. Tocolytics :In the preterm PROM patient should be limited to 48 hours duration.

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References
1. Current Obs-Gyn diagnosis and treatment.2003 2. Williams Obstetrics .2005 3. The Merck manual of diagnosis and therapy.1999

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Thank you
Murakoze
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