IN THE NAME OF GOD

PREMATURE RUPTURE OF MEMBRANES

definition

PROM is defined as the rupture of the chorioamniotic membrane before the onset of labor(uterine contractions)

PPROM

PROM before gestational age of 37 week

Latent phase: the priod between rupture of membranes

and beginning of uterine contractions

incidence

5-10 % of all term pregnancy PROM in 70% of all PROM begin in term pregnancies

PPROM in 1% of all pregnanciesPROM is acclerator of 1/3 of preterm pregnanciesIn pt with history of PPROM the incidence of recurrence is 32%

etiology

UnknownIn PROM may be weakness of physiologic

membranesSome of sub clinical infections may play a

role

Risk factors

1.cervical insufficiency: less than 25mm in 23 week

2.poly hydramnious3.history of pprom

4.prom fibronectin positive in week of 23

2. (+) culture of amniotic fluid seen in 30% of of pprom

3.recent inter course doesn’t have a role in PROM

4.cigarette and vaginal bleeding in third of three minester is associated with PROM

5. acute iflammation of placenta is seen in most cases of PROM

1.sub clinical infection: maybe one reason for prom , the relatinship between bacterial vaginosis and pre term labor or pprom show this fact

conclusions of PROM :

1. labor begins 24 hours after term PPROM in 80 – 90 % of cases2. tocolytic drugs : not useful , they must be less than 48 hour

complications :

1. RDS 2.hypoplasia of lung3.placenta detachment

*EVALUATION :

A. diagnosis:

1.history2.p/e : sterile spaculume , nitrazine test, ferning test, 3. sonography : oligo hydramnious4. fetal fibronectin5. dye injection

condition of cervix :

A. with sterile spaculume

B. trans vaginal sonography: no risk factor for infection in pprom

Infection

A. if PPROM is diagnosed : recto vaginal culture for GBS ,appropriate AB till coming culture B. chorioamnioutitis : in PPROM , tachycardia of mother and fetus , uterine tenderness, malodor pussy d/c

Infection

C. subclinical infection : assopciated with cerebral pulsy, amniocentesis(gram . Glucose .culture) , il-6 , biophysical profile

Treatment :

1. steroid befor delivery2. steriod in PPROM3.steroid in less than 28 wk without chorioamnioutits 4.exam with finger in chorioamnioutits5.AB prophylaxis

Maturation of lung :

1. PG

2. L/S

TREATMENT

Management of Premature Rupture of Membranes ChronologicallyGestational Age ManagementTerm (37 weeks or more)Near term (34 weeks to 36 completedweeks) :

• Proceed to delivery, usually by induction of labor• Group B streptococcal prophylaxis recommended• Same as for term

Preterm (32 weeks to 33 completedweeks) :• Expectant management, unless fetal pulmonarymaturity is documented• Group B streptococcal prophylaxis recommended• Corticosteroids—no consensus, but someexperts recommend• Antibiotics recommended to prolong latency ifthere are no contraindications

Preterm (24 weeks to 31 completedweeks) :• Expectant management• Group B streptococcal prophylaxis recommended• Single-course corticosteroid use recommended• Tocolytics—no consensus• Antibiotics recommended to prolong latency ifthere are no contraindications

Less than 24 weeks: • Expectant Management or induction of labor• Group B streptococcal prophylaxis is notrecommended• Corticosteroids are not recommended• Antibiotics—there are incomplete data on use inprolonging latency

THE END

BY: HAMZEH

HASHEMI