Premature rupture of membranes resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rinky Agnes Botleroo, M.B.B.S.

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Common risk factors in the development of PROM include :

• Maternal risk factors:
  • Sepsis
  • Previous history of PROM, recurrence risk is 16%–32% as compared with 4% in women with a prior uncomplicated term delivery)
  • Chronic steroid therapy
  • Abnormal bleeding during the second trimester or late in the pregnancy,
  • Low body mass index (BMI < 19.8 kg/m2)
  • Smoking and drug abuse
  • Low socioeconomic status
  • Deficiency of copper or vitamin C, along with connective tissue disorders such as Ehlers-Danlos syndrome, systemic lupus erythematosus are also linked to increased risk of PROM.
  • Direct abdominal trauma
  • Preterm labor
  • Anemia

• Uteroplacental Factors:
  • Uterine anomalies (such as uterine septum)
  • Placental abruption
  • Advanced cervical dilatation (cervical insufficiency)
  • Prior cervical conization
  • Cervical shortening in the 2nd trimester (< 2.5 cm)
  • Uterine overdistention (polyhydramnios, multiple pregnancy)
  • Intra-amniotic infection (chorioamnionitis)
  • Multiple bimanual vaginal examinations (but not sterile speculum or transvaginal ultrasound examinations)

• Fetal factors include :
  • Multiple pregnancy (preterm PROM complicates 7%–10% of twin pregnancies)
  • Prematurity
  • Infection
  • Cord prolapse
  • Malpresentation.

Diagnosis

Shown below is an algorithm summarizing the diagnosis of [[disease name]] according to the [...] guidelines.

History suggestive of PROM<be>(leakage of fluid from the vagina)

Physical examination findings confirm PROM •Pooling of fluid •Positive nitrazine and Ferning tests

Sterile speculum examination assess dilation and ultrasound if indicated

PROM ruled-out

PROM confirmed

Check gestational age •Arrange transportation to tertiary care if possible •Arrange prompt consult with obstetrician •Fetal non-stress test and ECG to assess well being

Induce delivery with oxytocin if at-term gestation

Plan delivery if any signs of infection, placental insufficiency, fetal distress, or active labor

24-31 weeks •Antibiotics+steroids •Delivery if lung maturity is satisfactory

32-33 weeks •Antibiotics+steroids •Delivery at 34 weeks or amniocentesis if abortion is suspected

34-36 weeks •Group B strep prophylaxis •Delivery

Treatment

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Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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