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Preterm prelabour rupture of membranes (PPROM) (Complications (foetus),…
Preterm prelabour
rupture of membranes (PPROM)
Definition
Rupture of membranes
before 37 weeks and before
onset of labour
Epidemiology
1/3 preterm deliveries
1/3 associated with infection
Pathophysiology
Often caused by chorioamnionitis
Significant foetal morbidity/mortality
and risk to the mother
Aetiology
Infection
Chorioamnionitis
Idiopathic
Unknown cause
Clinical
presentation
Vaginal loss
(trickle, dampness, gushing)
Vaginal discharge
(if infection)
Fever
(if infection)
Abdo pain/contractions
(if infection)
Diagnosis
Examination
Abdominal
Uterine pain/tenderness (infection),
contractions, foetal lie/engagement
Speculum
Offensive discharge, amniotic fluid
Pelvic exam
AVOID
- increased risk of infection
Investigations
Swabs
Amniotic fluid/discharge (HVS/LVS)
Bloods
FBC, CRP, U+E, LFTs,
clotting, group and save
Bedside
Maternal obs (BP, HR, sats, RR, temp)
Foetal obs (CTG)
Urine
Dipstick, MSU
Imaging
USS: foetus lie, presentation,
estimated weight, liquour
History
POH
Gravity/parity, conception, deliveries,
gestation, complications
PMH
Menses, contraception, STIs, smears
Current pregnancy
Gestation, bloods/scans, general health
PMH
Known conditions, abdo surgery
PC/HPC
Fluid loss PV, infection signs,
urinary/bowel symptoms
DH
Current meds, allergies
FH
Preterms, miscarriages
SH
Occupation, social support,
smoking, alcohol
Management
Medical
Abx
Indication: chorioamnionitis, idiopathic
E.g. broad-spec for chorio (per local guidelines);
erythromycin for idiopathic PPROM
Steroids
Indication: chorioamnionitis, idiopathic
E.g. betamethasone IM
Surgical
Delivery ASAP
Indication: chorioamnionitis
MOA: induction of labour or EmCS;
important to deliver whatever the gestation
Conservative
Establish cause
Admit, inform obstetrician and neonatal
Complications
(foetus)
Infection
Pulmonary hypoplasia
Prematurity
Limb contractures
Prognosis
If gestation at PPROM is <20wk, poor survival; >50% if >22wk
Better prognosis if secondary to iatrogenic procedure
e.g. amniocentresis versus spontaneous