Adrian Setiawan,M.

Prelabor rupture of membrane (PROM) is a rupture of membrane prior to the onset of labor. Preterm prelabor rupture of membrane (PPROM) is a rupture of membranes prior to 37 weeks gestation Spontaneous prelabor ROM is rupture of membranes after or with the onset of labor

Prolonged ROM is any rupture of membrane that persists for more than 24 hours and prior to onset of labor The latent period is the interval between the prelabor rupture of membranes and time of delivery

Incidence PROM varies between 3 18.5 % Approximately 8-10% of patients at term present with PROM PPROM accounts for 25 percent of all cases of PROM and is responsible for about 30% of all prelabor deliveries.

At term , programmed cell death and activation of catabolic enzymes such as collagenases and mechanical forces result in ruptured membranes. Preterm PROM probably in the same mechanism and premature activation of these pathways. However early PROM appears to be linked to underlying pathologic processes most likely due to inflammation or infection in membranes.

Other potential sources of insult are elaboration of proteases from seminal fluid or from bacteria that causes cervicovaginitis.

Lower socioeconomic status Smokers History of STD Previous preterm delivery, vaginal bleeding, uterine distention Procedures cerclage and amniocentesis

Patofisiologi PROM

NEMJ vol 338, 10. 1998

History of gush of fluid from the vagina followed by persistent leak Avoid digital cervical examination, perform speculum examination to confirm pooling of fluid in the vagina or leakage of fluid from cervix. Ferning of the dried fluid under microscopic examination

Alkalinity of the fluid as determined by Nitrazine or litmus paper

The most common complications of PPROM is early delivery. When PROM occurs too early neonate may develop malpresentation, cord compression, olygohydramnios, necrotizing enterocolitis, neurologic impairment, intraventricular hemorrhage and respiratory distress syndrome Chorioamnionitis

1. At term/near term : - induction of labor is advisable to reduce the risk of ascending infection. 2. 34 weeks or more : - Proceed to deliver, usually by induction of labor - Group B streptococcal prophylaxis is recommended

3. At 32 weeks to 33 completed weeks : - Expectant management unless fetal pulmonary maturity is documented - Group B streptococcal prophylaxis is recommended - Corticosteroids-no consensus, but some experts recommend - antimicrobial to prolong latency if no contraindications

4. At 24 weeks to 31 completed weeks : - expectant management - group B streptococcal prophylaxis is recommended - single course corticosteroids use is recommended - tocolytics-no consensus - antimicrobials to prolong latency if no contraindications

5. Before 24 weeks : - patient counseling - expectant management or induction of labor - group B streptococcal prophylaxis is not recommended - corticosteroids are not recommended - antimicrobials-there are incomplete data on use in prolonging latency

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