 Premature rupture of membranes (PROM) is the rupture of the

chorioamniotic membrane before the onset of labor.

 Preterm PROM (PPROM), defined as PROM that occurs before 37
weeks of gestation

Complications
 Fetal complications
o Cord prolapse & cord compression
o RDS
o IVH
o neonatal Infection
o necrotizing enterocolitis
 Maternal complication
o Chorioamnionitis
o Sepsis
o Placental abruption

Diagnosis
 Confirming that vaginal discharge is of leaking liquor
o Sterile speculum examination reveal that amniotic fluid is pass
through cervix, vaginal pooling of amniotic fluid
o Nitrazine tests: pH to distinguish amniotic fluid from urine and
vaginal secretions. Amniotic fluid is alkaline, having a pH above
7.1; vaginal secretions have a pH of 4.5
to 6.0, and urine has a pH of ≤6.0
o Fern tests: arborization that occurs
when amniotic fluid is placed on a slide
and is allowed to dry in room air. The
resultant pattern, which resembles the
leaves of a fern plant, is caused by the
sodium chloride content of the amniotic
fluid.
 o ultrasonographically guided transabdominal instillation of
indigo carmine dye, followed by observation for passage of
blue fluid from the vagina.

Evaluation
 monitor maternal vital signs
o fever & tachycardia >>> infection & Placental Abruption
o Suprapubic tenderness
o offensive Vaginal discharge
 Take cervical swab for Chlamydia & Gonorrhea infections. Anorectal
swab for GBS
 Blood test: CBC ( high WBC >>>infection) , CRP/ESR
 Urinalysis
 U/S: for amniotic fluid, presentation, fetal well-being, placental site
 CTG for fetal heart rate

Management

GA >34
labor should be induced at the time of presentation, generally with
oxytocin infusion, to reduce the risk of Chorioamnionitis

GA< 34
 Delivery, indicated in
o Onset of labour
o Chorioamnionitis
o Fetal distress
o Fetal maturity
o Fetal demise
o Eclampsia or severe pre-eclampsia
 Expectant management
o Monitor temperature & pulse rate 4-hourly
o Prophylactic anti-biotic : erythromycin + amoxicillin for 7 days
(2 d injections +5d oral)
o Corticosteroid
o Tocolytics
o If delivery is considered>>> GBS prophylaxis