KABWE CENTRAL HOSPITAL

OBGY-WLN

Late Pregnancy Complications

Premature Rupture of Membranes

Banda Wisdom Chilufya

Defination

• PROM –rupture of membranes before onset of

labour.
• If the rupture occurs before 37/40- pPROM
(preterm premature rapture of memranes
• Incidence 4-18% of pregnancies.
• Responsible for 50% preterm deliveries and 10%
perinatal mortality.
Aetiology

I. External factors eg amniocentesis, trauma

II. Hydrostatic problem-lack of resistance
– Congenital eg lack of Vit C, collagen disorders
– Acquired
• Infection
• Cervical surgery-cone biopsy
• multiple pregnancy
• polyhydramnios
Mode of action of infection

– Destruction by direct protease and

phospholipase bacterial production cause
weakness in membranes.

– Indirectly by via response fetal and maternal

macrophage-mediated enzyme secretion.

– Increase in PG production.
Clinical features

• Gush of fluid then leakage of fluid (main

presentation)
• Vaginal discharge
• Vaginal bleeding ( it mix with fluid )
• Pelvic pressure
• Urine incontinence ( actually it is leakage of fluid
but the women may get mistaken )
• No uterine contraction ( if there is contraction and
cervical change - labor )
Rupture of membrane diagnosed by

• Pooling of fluid in the vagina or leakage of fluid

from the cervix
• Leakage of fluid by cough or by fundal pressure
• ferning pattern of the dried fluid under microscopic
examination . (fluid crystallizes to form a fernlike
pattern due to the relative concentrations of NaCl,
proteins, and carbohydrates in the fluid)
• Nitrazine paper -turn blue ph>6 (blood, semen, or
bacterial vaginosis can give false positive)
Complications
• Maternal
– Infections(chorioamnionitis.endometritis)
– Sepsis
– DVT
– Abruptio placenta
• Fetal complications
– Fetal and neonatal
infections(sepsis,meningitis,bronchopneumonia)
– Cord prolapse
– Malpresentation
– Prematurity
– PDA
• Investigations
– Endocervical swab for m/c/s
– WCC total and differential
– ESR
– C-reative protein
• Fetal well being
– CTG,Kickchart,
`

• PROM at term or near term-best delivered

• 80% labour within first 24 hours, near to 10% next
24 hours
• Antibiotic cover after swab is taken
• Between 32 and 34 weeks give steroids to mature
lungs
• Under 32/40 aim to prolong gestation if there no
signs of fetal distress or infection
• Erythromycin 500 qid
• Metronidazole 400 tds
• Dexamethasone depending on gestation age
Chorioamnionitis

– Monitor temp, pulse ,fetal heart rate.

– Smell of liqour or pad.
– Tender irritable abdomen.
– Consider immediate delivery by fastest and safest route.
– Antibiotic cover
Summary of outcomes in draining

• Miscarriage
• Draining can stop & pregn can continue to term
(may re-occur)
• ARDS
• Chorioamnionitis
• Preterm delivery
• Contractures over joints of long bones
• Skeletal malformations (Tallipes-equino-varus)
 Measure your impact on
humanity not in likes, but in
the lives you touch, not in
popularity, but in the people
you save
Tim Cook