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The Preterm Parturition Syndrome

UterineOverdistension

Vascular

Infection

CervicalDisease

Hormonal

Immunological

VR RR MM

Unknown

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Definition and Scope

Rupture of the fetal membranes prior to

the completion of the 37th week of

pregnancy

May or may not be associated with PTL

Complicates 1/3 of all preterm deliveries

Around 1-2% of pregnancies

Majority of patients delivery within 1 week Management is controversial

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Problems are:

Fetus:

Prematurity

Ascending IU Infection

Abruption

Cord Accident Cord prolapse

Oligohydramnious

Arrest of pulmonary development

(Pulmonary Hypoplasia)

Potters syndrome (amniotic bands)

Skeletal deformities

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Maternal

Infection

Intra-amniotic in 13-60%

Postpartum in 2-13%

Thromboembolic disease

Hemorrhage

4-12% affected by abruption

Concealed hemorrhage

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Initial Exam

Fetal monitoring Sterile speculum exam

Nitrizine test

Vaginal fluid is acidic Amniotic fluid is basicwill turn paper

blue

Ferning

Use dry slide (no slip) Use low powerdont be fooled by

crystals

Val-salva

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DIAGNOSIS

Speculum: Flow of Liquor,

specific smell, vernix

Nitrazine test (Amnicator),

alkaline

USS

Avoid Vaginal examination Prefer to do speculum to see fluid

draining, HVS, cx dilatation or

cord prolapse

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Risk Factors

Infection seems to play a role,

but no single agent has been

identified Antibiotics do not seem to

prevent PPROM

Previous PPROM most importantrisk factor

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MANAGEMENT

Eventually will go in labour

Steroidsnot if infected

AntibioticsErythromycin,

prolong pregnancy and

decrease neonatal

complications

?Tocolysis

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Management Considerations When?

If pre-viable, may day care to return when

viable; antibiotics?, monitoring?

If later than 34 weeks, consider induction or

expectant managementliterature is

conflicting If

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Management Supported Interventions

Tocolysis for steroid administration if

no contraindications and fetus 24

34 weeks

Antibiotics for group-B strepprophylaxis AND for latency (add

erythromycin)

Ultrasound for fetal weight

Neonatal consultation

Expectant management for any

gestational age

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Frank discussion with parentswith mid-trimester PPROM

Some studies suggest that these

patients do well if there is some

fluid and pregnancy can beprolonged until after 26 weeks

Expectant management is

permissible as long as there are nocontraindications

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RISK-CHRIOAMNINITIS

Maternal pyrexia

Abdominal pain

Uterine tenderness

Raised white cell count

C reactive protein

HVS, Urine culture positive for

infection

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Regular fetal monitoring

Home/ inpatient

Regular temperature White cell count and C reactive

protein

High vaginal swabs

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Summary of PPROM

Initial Assessment

Gestational age

Confirm rupture Nitrizine

Ferning

Val-salva

Visual assessment of cervix Labor present / absent

Infection present / absent

Fetus reassuring or in distress

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REMEMBER

Prematurity is serious problem

Consider SteroidsTocolysis

Antibiotics if PPROM

Special care baby unit is essential