Premature ROM rupture of membranes prior to the onset of labour at any GA Prolonged ROM if 24 hours elapse between rupt...
Premature ROM
- rupture of membranes prior to the onset of labour at any GA
- if 24 hours elapse between rupture of membranes and onset of labour
- ROM occurring before 37 weeks gestation (associated with PTL)
PPROM
- preterm premature rupture of membranes (not in labour)
Associated Conditions
- congenital anomaly
- infection
Causes
- idiopathic (most common)
- frequently associated with
- multiparity
- cervical incompetence
- infection: cervicitis, vaginitis, STD, UTI
- multiple gestation
- family history of PROM
- low socioeconomic class/poor nutrition
- and other risk factors associated with PTL (see above)
- cord prolapse
- intrauterine infection (chorioamnionitis)
- premature delivery
- history of fluid gush or continued leakage
- avoid introducing infection with examinations (do not do a digital pelvic exam)
- sterile speculum exam
- pooling of fluid in the posterior fornix
- may observe fluid leaking out of cervix on valsalva
- amniotic fluid turns nitrazine paper blue (low specificity as can be blood, urine or semen)
- ferning (high salt content of amniotic fluid evaporates and looks like ferns under microscope)
- U/S
- cultures (cervix for GC, lower vagina for GBS)
- dependent upon gestational age; must weigh degree of prematurity vs risk of amnionitis and sepsis by remaining in utero
- < 24 weeks consider termination (poor outlook due to pulmonary hypoplasia)
- 26-34 weeks: expectant management as prematurity complications significant
- 34-36 weeks: ìgrey zone" where risk of death from RDS and neonatal sepsis is the same
- > 36 weeks: induction of labour since the risk of death from sepsis is greater than RDS
- assess fetal lung maturity by L/S ratio of amniotic fluid
- consider administration of betamethasone to accelerate maturity
- if not in labour or labour not indicated, consider antibiotics (controversial)
- admit and monitor vitals q4h, daily BPP and WBC count
