Premature Rupture Of the

Membranes
 Definitions
• PROM is defined as amniorrhexis prior to the
onset of labor at any stage of gestation.
• Amniorrhexis means spontaneous rupture of
membranes as opposed to amniotomy.
• PPROM is used to defined that the patient who
are preterm with ruptured membranes, whether
or not they have contractions.
Etiology and risk factors

• Vaginal and cervical infections

• Abnormal membrane physiology
• Incompetent cervix
• Nutritional deficiencies
 Diagnosis
• It is based on the history of vaginal loss of fluid
and confirmation of amniotic fluid in the vaginal
• A sterile vaginal speculum examination should be
performed
• Before labor, vaginal examination should not be
performed
• Carry out a complete ultrasonic examination
Confirmation of the diagnosis

• Testing the fluid with nitrazine paper, which

will turn blue in the presence of the
alkaline amniotic fluid
• Placing a sample on a microscopic slide, air
drying, and examining for ferning
Amnicator and Ferning pattern

Amniotic Fluid
Ferning Pattern
 Management
• General considerations
• Conservative expectant management
• Management of chorioamnionitis
• Tests of pulmonary maturity
 General considerations
• Membranes are a natural barrier to prevent
infections
• PPROM has high risks of infections and sepsus
• PPROM can lead to oligohydramnios
 Diagnosis of oligohydramnios
• Ultrasonic definition has been standadized
• Criteria include:
(1) measure the amniotic fluid present in 4
quadrands by vertical axis
(2) AFI: total being called the amniotic fluid index
(3) A value of less than 5 cm is considered abnormal
Oligohydramnios results in:
• Fetal crowding with thoracic compression
• Restriction of fetal breathing
• Disturbances of pulmonary fluid production and
flow
• Constaints placed on fetal movements in utero
can also result in positional skeletal abnomalities,
such as talipes equinovarus
 If PROM occurs at 36 weeks or later,
condition of the cervix is favorable,no
spontaneous contractions, labor should
be induced after 6-12 hours.

If PROM occurs prior to 36 weeks

gestation, we should manage as
followings:
 Laboratory tests
• Complete blood cells
• Gram stain and culture of amniotic fluid
• Pulmonary maturation studies of amniotic
fluid
 Conservative expectant
management
• The goal is to continue the pregnancy until the
lung profile is mature
• Take careful surveillance to diagnose subclinical
infection and chorioamnionitis
 Clinical signs and symptoms of
chorioamnionitis

• Maternal temperature is greater than 100.40F (380C)

• Fetal tachycardia
• A tender uterus
• Uterine irritability on nonstress testing
• White blood cells elevates
• Measure the amniotic fluid by ultranography
Management of
Chorioamnionitis
• Use antibiotics depends on cultures and
sensitivity
• Once antibiotics have been started, labor
should be induced
• Vaginal delivery or cesarean section
 Chorioamnionitis
Maternal fever > 38° C with
any 2 of the following:
– Increased white cell count
(> 15 x 109 / L)
– Maternal tachycardia
(> 100 bpm)
– Fetal tachycardia
(>160 bpm)
– Uterine tenderness
– Offensive smelling vaginal
discharge
– C-Reactive Protein > 40
Antibiotics :
Ampicillin (or amoxycillin) 2 g IV
every 6 hours
Gentamicin 5 mg / kg IV daily
Metronidazole 500 mg IV every
12 hours
If allergic to penicillin, give
clindamycin 450 mg IV in 50 –
100 mL over at least 20
minutes every 8 hours AND
gentamicin 5 mg / kg IV daily
until delivery
• Tocolytic therapy
• Use of corticosteriods
• Labor and delivery

They are just the same with preterm

labor
Tests of pulmonary maturity

• Lecithin/sphingomyelin (L/S) ratio

maturity > 2
• Lamellar body number density (LBND)
• Maturity > 46000L LBND
 Surfactant therapy

• It is effective in animal tests

• Only on human trials
THANK
YOU