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Page 1: Premature Rupture of Membranes (Prom)

PREMATURE RUPTURE OF

MEMBRANES (PROM)

KABERA René, MD

Resident PGY II- Family and Community Medicine

Obs-Gyn. Dept Ruhengeri Hospital

Feb 2010.

Page 2: Premature Rupture of Membranes (Prom)

ESSENTIALS OF DIAGNOSIS

• History of a gush of fluid from the vagina or

watery vaginal discharge.

• Demonstration of amniotic fluid leakage from

the cervix.

• ≥1h before the onset of labor.

KABERA René ,MD PGY II FAMCO NUR

Page 3: Premature Rupture of Membranes (Prom)

General Considerations

• Rupture of the membranes may happen at

any time during pregnancy.

• It becomes a problem if the fetus is preterm

(preterm) .

• >24 Hrs, prolonged premature rupture of

membranes -time between rupture of the membranes and the onset of labor is.

KABERA René ,MD PGY II FAMCO NUR

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General considerations c’t

• 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).

KABERA René ,MD PGY II FAMCO NUR

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Pathophysiology

• PROM is an important cause of preterm labor, prolapse of the cord, placental abruption, and intrauterine infection.

• In extremely prolonged PROM, the fetus may have an appearance similar to that of Potter's syndrome (eg, extraordinary flexion, wrinkling of the skin).

• If PROM occurs at less than 26 weeks' EGA, it can cause pulmonary hypoplasia and limb positioning defects in the newborn.

KABERA René ,MD PGY II FAMCO NUR

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Clinical findings

• Symptoms

• The patient usually reports a sudden gush of

fluid or continued leakage.

• Reduced size of the uterus, and increased

prominence of the fetus to palpation.

• Sterile Speculum Examination

• Pooling , Nitrazine test, Ferning.

KABERA René ,MD PGY II FAMCO NUR

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Lab test

• CBC , CRP, U/S, Amniocentesis for lung

maturation

• Amniotitis : most common germ is

streptococci B-fever ,leukocytosis (>16000

WBC),uterine tenderness, tachycardia ( >100

btm-mother,>160 btm-fetus ),foul smelling amniotic liquid .

KABERA René ,MD PGY II FAMCO NUR

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Management

• A.Amniotitis :

delivery regardless of gestational age. Broad-

spectrum antibiotics should be started. if no labor

, labor should be induced to expedite delivery.

• B. Term Pregnancy Without Amnionitis:

• 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 the risk of infection.

KABERA René ,MD PGY II FAMCO NUR

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Management c’t

• 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.

• 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.

KABERA René ,MD PGY II FAMCO NUR

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Management c’t

• For pregnancies with PROM between 24 and

32 weeks' EGA.

• Antibiotics.

• Corticosteroids.

• Tocolytics :In the preterm PROM patient should be limited to 48 hours duration.

KABERA René ,MD PGY II FAMCO NUR

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References

• Current Obs-Gyn diagnosis and treatment.2003

• Williams Obstetrics .2005

• The Merck manual of diagnosis and therapy.1999

KABERA René ,MD PGY II FAMCO NUR

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Thank you

Murakoze

KABERA René ,MD PGY II FAMCO NUR