17. Premature Rupture of Membranes Prom

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17. Premature Rupture of

Membranes (PROM)

Study Session 17 Premature Rupture of Membranes (PROM).....................................3

Introduction................................................................................................................3

Learning Outcomes for Study Session 17..................................................................3

17.1 Premature rupture of membranes......................................................................3

17. !"assifications of PROM...................................................................................#

17.3 Ris$ factors for PROM......................................................................................#

17.3.1 Infection can cause PROM.........................................................................%

&o' 17.1 idence of infection in a *oman *it+ PROM.....................................%

17.3. Ma"presentation of t+e fetus.......................................................................%

17.3.3 Mu"tip"e pregnancy and e'cess amniotic f"uid...........................................%

17.3.# !erica" incompetence...............................................................................%

17.3.% ,rauma to t+e abdomen..............................................................................-

17.# iagnosis of PROM..........................................................................................-

&o' 17.1 !"inica" features of PROM....................................................................-

17.% !omp"ications of PROM...................................................................................7

17.%.1 Infection after PROM.................................................................................7

/uestion.................................................................................................................7

0ns*er...................................................................................................................7

17.%. !ord pro"apse.............................................................................................7

17.%.3 eta" +ypo'ia and asp+y'ia........................................................................2

17.%.# P"acenta" abruption.....................................................................................2

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17.%.% Preterm "abour............................................................................................2

17.%.- eformity of feta" "imbs.............................................................................2

17.- 0ctions in a case of PROM.............................................................................1

17.-.1 4+en s+ou"d you conduct t+e de"iery before referra"5..........................1

/uestion...............................................................................................................1

0ns*er.................................................................................................................1

17.-. 4+en s+ou"d you refer before conducting t+e de"iery5..........................11

Summary of Study Session 17.................................................................................1

Se"f60ssessment /uestions (S0/s) for Study Session 17.......................................1

S0/ 17.1 (tests Learning Outcomes 17.1 and 17.)...........................................13

0ns*er.................................................................................................................13

S0/ 17. (tests Learning Outcomes 17.1 17.3 17.# and 17.%).........................13

0ns*er.................................................................................................................1#

!ase Study 17.1 8ufan9s story............................................................................1#

S0/ 17.3 (tests Learning Outcomes 17.1 17. 17.% and 17.-).........................1#

0ns*er.................................................................................................................1#



Study Session 17 Premature Rupture of

Membranes (PROM)

Introduction

In t+is study session you *i"" "earn t+e definition c"assification and ris$ factors of

premature rupture of membranes (PROM). 4e *i"" describe t+e potentia"

comp"ications t+at may end up *it+ serious materna" morbidity and at t+e *orst

materna" morta"ity.

,+is session a"so te""s you about t+e potentia" comp"ications t+at endanger t+e "ife of

t+e fetus and t+e ne*born baby. :ou *i"" "earn +o* to ma$e a c"inica" diagnosis of

PROM and *+at actions you can ta$e *+en you +ae *omen *it+ PROM bui"ding

on your e'isting $no*"edge about "ea$age of f"uid from t+e agina as one of t+edanger symptoms in Study Session 1%.

Learning Outcomes for Study Session 17

4+en you +ae studied t+is session you s+ou"d be ab"e to;

17.1 efine and use correct"y a"" of t+e $ey *ords printed in bold.

(S0/ 17.1 17. and 17.3)

17. escribe t+e c"assification of PROM. (S0/ 17.1 and 17.3)

17.3 escribe t+e different ris$ factors associated *it+ PROM. (S0/ 17.)

17.# efine t+e diagnostic features of PROM. (S0/ 17.)

17.% iscuss t+e possib"e comp"ications of PROM affecting t+e mot+er and t+e fetus.

(S0/ 17. and 17.3)

17.- 'p"ain *+at action you need to underta$e *+eneer you come across a *oman

*it+ PROM. (S0/ 17. and 17.3)

17.1 Premature rupture of membranes

Premature rupture of membranes (PROM) is defined as a spontaneous "ea$age of

amniotic f"uid from t+e amniotic sac *+ere t+e baby s*ims< t+e f"uid escapes t+roug+

ruptured feta" membranes occurring after = *ee$s of gestation and at "east one +our

before t+e onset of true "abour. PROM can occur before or after # *ee$s9 gestation

so t+e *ord >premature9 does not mean t+at t+e gestationa" age of t+e fetus is preterm.

Premature +ere refers to t+e premature rupture of feta" membranes before t+e onset of

"abour. PROM is of concern because rupture of feta" membranes before t+e onset of"abour is not norma" and is associated *it+ many comp"ications (described "ater in t+is

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session). In a norma" "abour t+e feta" membranes usua""y rupture after t+e "abour +as

progressed for some time *+en t+e feta" +ead is deep"y engaged and t+e ceri' is

near to fu"" di"atation *it+ no comp"ications in most "abouring *omen. (:ou *i""

"earn in detai" about "abour progress in t+e ne't Modu"e Labour and Delivery Care.)

:ou need to $no* t+at t+e ma?ority of peop"e in t+iopia don9t t+in$ of PROM as a prob"em. Rat+er t+ey consider t+e "ea$age of f"uid as a good symptom about t+e

coming "abour. 0s you *i"" see "ater in t+is study session many serious comp"ications

can occur as a resu"t of PROM. ,+erefore you need to counse" t+e *oman +er

+usband@partner and +er fami"y ery c"ear"y about t+e actions t+ey s+ou"d ta$e if +er

membranes rupture and f"uid "ea$s from +er agina before "abour begins. ,e"" t+em

about t+e dangers of *aiting at +ome after t+e rupture of feta" membranes. 4e begin

by describing +o* you c"assify cases of PROM *+ic+ determines +o* you +and"e

eac+ case.

17. !lassifications of PROMPROM is c"assified according to t+e gestationa" age at *+ic+ it occurs and t+e intera"

bet*een rupture of t+e feta" membranes and t+e onset of true "abour.

Preterm PROM occurs after = *ee$s of gestationa" age and before 37 *ee$s.

"erm PROM occurs after 37 comp"eted *ee$s of gestationa" age inc"uding post6

term cases occurring after # *ee$s.

Preterm and term PROM are furt+er diided into;

• #arly PROM ("ess t+an 1 +ours +as passed since t+e rupture of feta"

membranes)

• Prolonged PROM (1 or more +ours +as passed since t+e rupture of feta"

membranes).

,+e ma?or reason for c"assifying PROM into term preterm ear"y and pro"onged

PROM is for effectie management decisions. ,+e earlier t+e occurrence (preterm

PROM) and t+e longer t+e intera" bet*een t+e rupture of feta" membranes and onset

of "abour t+e more comp"ications t+ere are "i$e"y to be. 4e *i"" describe t+e actions

you s+ou"d ta$e to manage cases of PROM in Section 17.- of t+is study session. irst

*e discuss t+e ris$ factors for PROM and t+en t+e comp"ications t+at can resu"t for

t+e mot+er and t+e fetus.

17.$ Ris% factors for PROM

Rupture of feta" membranes can occur *+en t+e ceri' is eit+er c"osed or di"ated.

Sometimes it can occur in a ery ear"y pregnancy (before = *ee$s A t+is "eads to

ineitab"e abortion *+ic+ you *i"" "earn about in Study Session ) or in ear"y t+ird

trimester (bet*een = and 3# *ee$s). It is not e'act"y $no*n *+y feta" membranes

rupture before t+e onset of "abour. Bo*eer t+ere are some $no*n ris$ factors +ig+"y

associated *it+ PROM.

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!onsider t+e amniotic caity as a sac (or bag) *+ose *a"" is formed by t+e feta"

membranes enc"osing t+e fetus and amniotic f"uid. ,+e sac *i"" rupture at t+e *ea$est

point *+ic+ is t+e part of t+e membranes in direct contact *it+ t+e >mout+9 of t+e

ceri'. Rupture +appens *+en t+e sac is eit+er damaged by an infection or e'terna"

trauma or it becomes oer6stretc+ed (distended) and unab"e to *it+stand t+e interna"

pressure. ,+ese ris$ factors are described in more detai" be"o*.

17.$.1 Infection can cause PROM

&acteria t+at cause infection in t+e "o*er genita" tract (infection of t+e ceri' or

agina" *a"") can trae" up*ards t+roug+ t+e ceri' and infect t+e feta" membranes.

,+is can *ea$en t+e membranes enoug+ to a""o* t+em to rupture.

&o' 17.1 summarises t+e diagnostic signs of infection in a *oman *it+ PROM.

&o' 17.1 #idence of infection in a oman it* PROM

• eer; t+e *oman may comp"ain of fee"ing feeris+ or you may record +er

temperature of 3=C! or more.

• ,+e agina" disc+arge may +ae an offensie sme"" and t+e co"our may be

c+anged from *atery to c"oudy.

• S+e may +ae an increased pu"se rate (more t+an 1 beats@minute).

• ,+e feta" +eart beat may increase to 1- beats@minute or more.

• S+e may fee" pain in t+e "o*er abdomen particu"ar"y *+en it is touc+ed.

17.$. Malpresentation of t*e fetus

Rupture of feta" membranes is +ig+"y associated *it+ feta" ma"presentations in t+e

t+ird trimester. Particu"ar"y +ig+ ris$ of PROM is associated *it+ foot"ing breec+ (feet

first) and transerse "ie (across t+e abdomen) *it+ t+e baby9s bac$ arc+ed up*ards

and +ands and "egs pointing do*n in direct contact *it+ t+e *ea$est point of t+e

membranes.

17.$.$ Multiple pregnancy and e'cess amniotic fluid

If t+e uterus +o"ds t*o or more babies or t+ere is e'cess accumu"ation of amniotic

f"uid (po"y+ydramnios) t+e feta" membranes become oer6stretc+ed and rupture. ,+e

membranes can rupture een if t+e amount of amniotic f"uid is sma"" if t+ere is

anot+er cause suc+ as t+ose described be"o*.

>Po"y9 means e'cess >+ydra9 means *ater and >amnios9 refers to t+e amniotic f"uid.

So >po"y+ydramnios9 means >too muc+ amniotic f"uid9.

17.$.+ !erical incompetence

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4it+out uterine contraction t+e ceri' may di"ate spontaneous"y ear"y in gestation

and t+is can be t+e cause for an abortion (miscarriage). ,+e ceri' may di"ate een in

"ate pregnancy before t+e onset of "abour. 0s t+e ceri' continues di"ating it *i""

a""o* part of t+e feta" membranes to pass t+roug+ it. 0s a resu"t t+e membranes can

rupture easi"y and "ea$ amniotic f"uid.

17.$., "rauma to t*e abdomen

0ny b"unt or penetrating trauma to t+e abdomina" *a"" can resu"t in a brea$ in t+e

feta" membranes. &"unt traumas inc"ude; uterine manipu"ation by a doctor or mid*ife

to c+ange t+e feta" presentation from breec+ or transerse "ie to t+e norma" >+ead

do*n9 or erte' presentation< uterine massage by traditiona" +ea"ers< and b"unt

abdomina" in?ury (e.g. from a b"o* or fa""). 0n e'amp"e of a penetrating abdomina"

in?ury is insertion of a +o""o* need"e into t+e amniotic caity t+roug+ t+e abdomina"

*a"" or t+roug+ t+e ceri' to *it+dra* amniotic f"uid or p"acenta" tissue for ana"ysis.

17.+ -iagnosis of PROM

4+en t+ere is a rupture in t+e feta" membranes t+e *oman notices a pain"ess sudden

"ea$age of f"uid from +er agina *+ic+ is usua""y e'cess and *atery. Bo*eer *+en

t+e amount of amniotic f"uid in t+e sac is minima" t+e "ea$ing f"uid may on"y *et +er

under*ear and you may be unsure *+et+er to ma$e t+e diagnosis of PROM from t+e

*oman9s comp"aint.

,+e mot+er may be *orried but not be sure *+et+er t+e "ea$age is norma" or

abnorma". 0 "itt"e bit of e'cess agina" disc+arge is norma" near to fu"" term and t+is

may be confused *it+ t+e "ea$age of amniotic f"uid. So you need to refer any *omancomp"aining of e'cess agina" disc+arge for furt+er ea"uation at a +ig+er "ee" +ea"t+

faci"ity in case t+e *oman is s+o*ing signs of PROM.

&o' 17.1 summarises t+e c"inica" features t+at can +e"p you to ma$e t+e diagnosis of

PROM.

&o' 17.1 !linical features of PROM

• ,+e *oman comp"ains of "ea$age of f"uid from +er agina (minima" or

e'cess).• S+e says s+e noticed a decrease in t+e siDe of +er abdomen after "ea$age of

f"uid.

• :ou obsere *atery f"uid coming out t+roug+ t+e agina or t+e *oman9s

under c"ot+ing is soa$ed *it+ *atery f"uid.

• 4+en you measure t+e distance bet*een t+e pubic symp+ysis and t+e funda"

+eig+t (as described in Study Session 2) you find t+e baby is sma"" for

gestationa" age. (Eote t+at being >sma"" for gestationa" age9 can a"so be due to

scanty amount of amniotic f"uid *it+ intact membranes intrauterine gro*t+

restriction and *rong date for t+e stated gestationa" age.)

-



• In PROM t+e amniotic f"uid remaining in t+e sac *i"" be minima" so you may

be ab"e to fee" (pa"pate) t+e feta" parts easi"y t+roug+ t+e mot+er9s abdomen.

• 0"t+oug+ not specific t+e *oman may +ae an offensie sme"" due to agina"

disc+arge and s+e may +ae a feer (see &o' 17.1 aboe)< t+ese signs indicate

an a"ready estab"is+ed infection *+ic+ may be t+e cause of PROM.

• :ou can gie +er a dry agina" pad or Fot+ and c+ec$ after some +ours

*+et+er it is *et or sti"" dry. Eote t+at being dry doesn9t necessari"y ru"e out

PROM.

17., !omplications of PROM

PROM is associated *it+ seera" potentia""y "ife6t+reatening comp"ications as *e *i""

no* describe.

17.,.1 Infection after PROM

0s stated ear"ier t+e premature rupture of feta" membranes a""o*s bacteria to get into

t+e uterine caity. ,+ey mu"tip"y rapid"y in t+e *arm *et enironment and as a

resu"t bot+ t+e mot+er and t+e fetus may dee"op a "ife6t+reatening infection. It can

continue een after t+e birt+ as uterine or *idespread infection in t+e mot+er and

cause pneumonia sepsis (b"ood infection) or meningitis (infection of t+e brain) in t+e

ne*born.

Infection is one of t+e most feared comp"ications of PROM because un"ess it is

Guic$"y treated it may end up *it+ bot+ materna" and feta" or ne*born deat+. &ut t+egood ne*s is t+at s*ift treatment *it+ antibiotics is genera""y successfu".

It s+ou"d be noted t+at prolonged PROM cases are +ig+"y "i$e"y to dee"op a uterine

infection un"ess treated Guic$"y *it+ preentie antibiotics.

uestion

4+y do you t+in$ pro"onged PROM is particu"ar"y "i$e"y to "ead to infection5

/nser

Oer 1 +ours +ae passed since t+e feta" membranes ruptured so any bacteria t+at

got into t+e uterus +ae enoug+ time to mu"tip"y and ta$e +o"d.

nd of ans*er

17.,. !ord prolapse

7



igure 17.1 Pro"apsed cord is a dangerous comp"ication of PROM.

One of t+e potentia""y fata" comp"ications of PROM for t+e baby is umbilical cord

prolapse. (,+e term >pro"apse9 means >pus+ing out of t+e proper p"ace9.) 4+en t+e

membranes rupture t+e umbi"ica" cord may be *as+ed do*n*ards by t+e rus+ing out

of amniotic f"uid and fa"" to*ards t+e agina. It may be pus+ed a+ead of t+e baby and pus+ out into t+e ceri' (see igure 17.1) t+roug+ t+e brea$ in t+e membranes. In t+is

position t+e pro"apsed cord is easi"y compressed cutting off t+e b"ood supp"y to t+e

fetus and t+is can be t+e cause of sudden feta" deat+.

17.,.$ 0etal *ypo'ia and asp*y'ia

4+en t+e ruptured feta" membranes +ae "ea$ed most of t+e f"uid t+at $eeps t+e fetus

>f"oating9 in t+e uterus t+e membranes co""apse around t+e baby and t+e baby can

press against t+e uterine *a"". It can "ie on and compress t+e umbi"ica" cord so t+e

fetus becomes s+ort of o'ygen and t+e *aste product carbon dio'ide bui"ds up in its

body.

eficiency of o'ygen and accumu"ation of carbon dio'ide in t+e body is ca""ed

*ypo'ia ("itera""y >"o* o'ygen9) *+ic+ rapid"y "eads to asp*y'ia (brain and tissue

damage due to +ypo'ia) resu"ting in deat+ if o'ygen is not Guic$"y restored.

,+e fetus can a"so dee"op asp+y'ia and die because of partia" or comp"ete p"acenta"

abruption as described ne't.

17.,.+ Placental abruption

4+en t+e cause of t+e rupture of feta" membranes is an oer6stretc+ed uterus t+ere is

a possibi"ity of premature separation of t+e p"acenta from t+e uterine *a"" (a condition

ca""ed placental abruption *+ic+ you *i"" "earn more about in Study Session 1). ,+is

can +appen *+en a gus+ of f"uid sudden"y f"o*s out of t+e uterus ripping part of t+e

p"acenta a*ay from t+e uterine *a"".

17.,., Preterm labour

Once t+e feta" membranes rupture "abour usua""y starts spontaneous"y in "ess t+an one

*ee$. If t+e PROM occurs seera" *ee$s before t+e pregnancy reac+es fu"" term t+e

resu"ting "abour *i"" a"so be preterm and t+is can pose a ris$ to t+e ne*born. Its

dee"opment may not be sufficient"y mature to sustain "ife H for e'amp"e t+e

preterm baby cannot maintain its body temperature as *e"" as a fu"" term baby its

respiration *i"" be s+a""o* it may +ae troub"e feeding and its immune system may

not be ab"e to protect it from infection.

17.,. -eformity of fetal limbs

Sometimes "abour does not start spontaneous"y after PROM. ,+is is t+e most ris$y

situation for dee"opment of infection and feta" deformity if it occurs too ear"y in

gestation and t+e pregnancy continues for a "ong period of time after t+e membranes+ae ruptured.

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4it+out t+e amniotic f"uid to $eep t+e fetus >f"oating9 t+e muscu"ar *a""s of t+e

uterus c"ose"y surround t+e fetus and compress it. ,+e immature feta" bones are not

yet strong enoug+ to resist t+e pressure and t+e c+ance of dee"oping deformity of t+e

"egs feet arms or +ands is ery +ig+ if t+e pregnancy continues in t+is state for more

t+an 3 *ee$s.

17. /ctions in a case of PROM

4+eneer you see a *oman *it+ c"ear"y defined or suspected PROM t+e Guestions

you need to ans*er are;

1. oes t+e *oman +ae estab"is+ed "abour or not5

. If t+e *oman +as estab"is+ed "abour;

o Is it preterm or term PROM5

o Bo* "ong +as s+e stayed at +ome after t+e membranes ruptured5

o Bo* muc+ +as t+e "abour progressed5

3. Is t+e fetus a"ie or dead5

#. Irrespectie of "abour condition does t+e *oman +ae estab"is+ed infection or

not5

:ou need to ans*er t+e aboe Guestions because t+ey s+o* *+at actions you need to

ta$e as *e *i"" no* describe.

17..1 2*en s*ould you conduct t*e deliery before referral3

nder certain conditions it is safer for you to conduct t+e de"iery of a *oman *it+

PROM *+ere s+e is (at +er +ome or your Bea"t+ Post) before referra".

uestion

!an you e'p"ain *+y not5

/nser

It great"y increases t+e ris$ of infection getting into t+e uterus.

nd of ans*er

:ou s+ou"d support +er t+roug+ t+e "abour before referra" if s+e is;

1



on

9t do an interna" agina" e'amination een *earing surgica" g"oes in a *oman *it+

PROMJ

• a"ready in established labour (yes to /uestion 1 aboe)

• and s+e came to you *it+ a +istory of term PROM after 37 comp"eted *ee$s

of gestation and t+e "ea$age of f"uid +appened before t+e onset of "abour

(/uestion )

• and you see no evidence of infection (no to /uestion #).

If t+e "abour and de"iery *as norma" and t+e *oman and baby are doing *e"" c+ec$

t+em for t+e ne't # +ours. ,e"" t+e fami"y to ca"" you and ta$e +er to a +ea"t+ faci"ity

immediate"y if t+ere is any sign of infection in t+e mot+er or t+e ne*born.

If t+e *oman comes to you *it+ PROM and s+e is a"ready in estab"is+ed "abour

*+ic+ +as progressed a "ong *ay ("ate actie first stage or second stage *+en t+e

*oman is *anting to pus+) even with evidence of infection, or a preterm labour, or

you thin the fetus may be dead it is sti"" preferab"e to conduct t+e de"iery *+ere t+e

*oman is and refer +er to a +ea"t+ faci"ity as soon as t+e baby is born.

17.. 2*en s*ould you refer before conducting t*e deliery3

11



Refer t+e *oman *it+ PROM as soon as possib"e to a +ospita" *it+ a surgica" faci"ity

if s+e is not in "abour or s+e is sti"" in t+e ear"y stage of "abour and t+ere is time to get

+er to t+e +ea"t+ faci"ity before "abour progresses muc+. Remember t+at if t+e case is

preterm PROM t+e ne*born *i"" need specia" care in a +ospita".

Summary of Study Session 17

In Study Session 17 you "earned t+at;

1. Premature rupture of membranes (PROM) is a spontaneous rupture of feta"

membranes and "ea$age of f"uid from t+e agina after = *ee$s of gestation

and at "east one +our before t+e onset of true "abour.

. PROM is c"assified as preterm PROM *+en t+e "ea$age of f"uid occurs before

37 comp"eted *ee$s of gestation and term PROM *+en it occurs after 37

*ee$s.

3. 4omen *it+ pro"onged PROM (1 or more +ours passed since t+e rupture of

feta" membranes) are +ig+"y "i$e"y to dee"op infection in t+e uterus un"ess t+ey

get s*ift antibiotic treatment.

#. ,+e commonest ris$ factors for PROM inc"ude infection in t+e reproductie

tract feta" ma"presentations (breec+ or transerse "ie) mu"tip"e pregnancy

e'cess amniotic f"uid cerica" incompetence and abdomina" trauma.

%. ,+e diagnosis of PROM is based on a +istory of sudden and pain"ess "ea$age

of moderate or e'cess *atery f"uid from t+e agina. :ou may *itness t+e

*oman9s soa$ed under*ear fee" easi"y pa"pab"e feta" parts t+roug+ +erabdomina" *a"" and measure t+e uterine siDe as >sma"" for gestationa" age9

because +er abdomen +as s+run$.

-. ,+e common comp"ications of PROM are infection in t+e mot+er and@or t+e

fetus@ne*born cord pro"apse intrauterine feta" asp+y'ia@deat+ p"acenta"

abruption preterm "abour and deformity of t+e feta" "imbs.

7. eer fou" sme""ing agina" disc+arge increased materna" pu"se rate

increased feta" +eartbeat and "o*er abdomina" pain are signs of infection in t+e

uterine caity *+ic+ needs to be treated Guic$"y *it+ antibiotics.

=. ,o minimiDe t+e ris$ of infection g"oed digita" pe"ic e'amination s+ou"d be

aoided in *omen *it+ PROM.

2. e"ier t+e baby and t+en refer in cases of term or preterm PROM *+ere t+e

*oman is a"ready in adanced "abour een if t+ere is eidence of infection or in

cases of term PROM if "abour +as begun norma""y and t+ere is no eidence of

infection.

1. Refer as soon as possib"e a"" *omen *it+ PROM coming to you before t+e

onset of "abour or in ear"y "abour *it+ estab"is+ed materna" or neonata"infection< refer a"" preterm babies immediate"y after de"iery.

1



11. Ma$e sure t+at t+e *oman *it+ PROM and +er fami"y are *e"" a*are of t+e

ris$s of *aiting at +ome< counse" t+em to ca"" you at once and ta$e transport to

t+e +ea"t+ faci"ity.

Self4/ssessment uestions (S/s) for Study Session

17

Eo* t+at you +ae comp"eted t+is study session you can assess +o* *e"" you +ae

ac+ieed its Learning Outcomes by ans*ering t+e fo""o*ing Guestions. 4rite your

ans*ers in your Study iary and discuss t+em *it+ your ,utor at t+e ne't Study

Support Meeting. :ou can c+ec$ your ans*ers *it+ t+e Eotes on t+e Se"f60ssessment

/uestions at t+e end of t+is Modu"e.

S/ 17.1 (tests Learning Outcomes 17.1 and 17.)

!omp"ete t+e missing information in ,ab"e 17.1.

"able 17.1

PROM classification 5estational age

Preterm PROM

,erm PROM

Interal since membranes ruptured

ar"y PROM

Pro"onged PROM

/nser

,+e comp"eted ,ab"e 17.1 s+ou"d "oo$ "i$e t+is;

"able 17.1

PROM classification 5estational age

Preterm PROM 0fter = *ee$s and before 37 *ee$s

,erm PROM 0fter 37 *ee$s inc"uding post6term (after # *ee$s)

Interal since membranes rupturedar"y PROM Less t+an 1 +ours

Pro"onged PROM More t+an 1 +ours

nd of ans*er

S/ 17. (tests Learning Outcomes 17.16 17.$6 17.+ and 17.,)

4+ic+ of t+e fo""o*ing statements is false5 In eac+ case e'p"ain *+at is incorrect.

0 Infection in t+e uterus may cause PROM and may a"so be a comp"ication fo""o*ingPROM.

13



& PROM may occur if t+e uterus is oer6stretc+ed by ma"presentation of t+e fetus

mu"tip"e pregnancy or e'cess amniotic f"uid.

! !erica" incompetence in combination *it+ PROM can be a cause of umbi"ica"

cord pro"apse.

,+e feta" membranes are so strong t+at b"unt trauma to t+e abdomen is un"i$e"y to

cause PROM.

Bypo'ia and asp+y'ia of t+e *oman in "abour is a common comp"ication of

pro"onged PROM.

0 sudden gus+ of c"ear *atery f"uid from t+e agina is a"*ays seen in cases of

PROM.

/nser

0 is true. Infection in t+e uterus may cause PROM and may a"so be a comp"ication

fo""o*ing PROM.

& is true. Prom may occur if t+e uterus is oer6stretc+ed by ma"presentation of t+e

fetus mu"tip"e pregnancy or e'cess amniotic f"uid.

! is true. !erica" incompetence in combination *it+ PROM can be a cause of

umbi"ica" cord pro"apse.

is false. &"unt trauma to t+e abdomen is a common cause of PROM.

is false. Bypo'ia and asp+y'ia of t+e fetus (not t+e *oman in "abour) is a common

comp"ication of pro"onged PROM.

is false. Some cases of PROM occur without a sudden gus+ of c"ear *atery f"uid

from t+e agina so you s+ou"d a"*ays ta$e account of ot+er diagnostic signs suc+ as

reduction in siDe of t+e abdomen and c"ear"y pa"pab"e feta" parts.

nd of ans*er

Read !ase Study 17.1 and t+en ans*er t+e Guestions t+at fo""o* it.

!ase Study 17.1 ufan8s story

8ufan9s fami"y contact you to say t+at +er *aters bro$e # +ours ear"ier but t+ey are

concerned because +er "abour +as not started yet. ,+ey t+in$ t+e baby *as due to be

born "ast *ee$. S+e fee"s +ot to t+e touc+ and is becoming rest"ess and comp"aining of

pain in +er "o*er abdomen.

S/ 17.$ (tests Learning Outcomes 17.16 17.6 17., and 17.)

1. Bo* do you c"assify 8ufan9s case of PROM5

1#



. oes s+e +ae t+e signs of any comp"ications5

3. Is t+ere anyt+ing you cou"d +ae done to preent +er condition from

*orsening5

#. 4+at immediate action s+ou"d you ta$e5

/nser

1. 8ufan9s condition s+ou"d be c"assified as post6term pro"onged PROM because

t+e gestationa" age is a"ready beyond # *ee$s and +er membranes ruptured

more t+an 1 +ours ago.

. S+e +as t*o c"ear signs of abdomina" infection; feer and "o*er abdomina"

pain.

3. :ou cou"d +ae preented +er condition from *orsening if you +ad counse""ed

8ufan and +er fami"y more c"ear"y about t+e ris$s of *aiting at +ome after t+e

membranes +ae ruptured.

#. :ou s+ou"d immediate"y refer +er to t+e nearest +ospita" or +ea"t+ centre *it+

surgica" faci"ities< s+e *i"" a"so need antibiotics Guic$"y to treat t+e infection.

nd of ans*er

1%

17. Premature Rupture of Membranes Prom

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Transcript of 17. Premature Rupture of Membranes Prom