Clinical Case Presentation:

PREMATURE RUPTURE OF
MEMBRANES

QUITORIANO, KRIZA D.
General Data
• T.G.
• 14 y.o.
• Single
•Catholic
• G1P0 PU 36 2/7 WAOG by LMP
Chief Complaint

Watery vaginal discharge

HPI
• ↓ fetal movement
16 hrs PTA • (-) vaginal bleeding
• (-) hypogastric pain

• (+) watery vaginal discharge

30 mins • (-) hypogastric pain
PTA • (+) ↓ fetal movement
Past Medical History
• (-) HPN
• (-) DM
• (-) Goiter
• (-) Allergies
• (-) BA
• (-) hospitalization
• (-) surgery
Physical Exam
• Conscious
General Survey • Coherent
• Not in cardio-respiratory distress
Vital Signs 120/80 mmHg 112 bpm 19 cpm 36.8 °c
HEENT AS, PPC, (-) TPC, (-) CLAD
CARDIO AP, no murmur
CHEST AND LUNGS SCE, (-) retractions, (-) lagging, CBS
SPINE AND Grossly normal extremities, (-) cyanosis, (-)
EXTREMITIES edema
Physical Exam
Abdomen • Globular
• Non tender
FH 28 cm
FHT 146
SE • grossly normal external genitalia
• smooth vaginal wall,
• pinkish cervix
• (-) erosions
• (-) lesions
• (+) pooling of clear AF
Menstrual History
M 11 years old
I Regular; 30 days
D 7 days

A 3 pads/day; moderately soaked

S (+) dysmenorrhea
Hema 01-02-2018 Hema 01-03-2018 UA 01-02-2018

Hgb 123 Hgb 113 RBC Over 50

Hct 0.370 Hct 0.329 WBC 18-20

WBC 18

PC adequate
Admitting Impression
G1 P0 Pregnancy Uterine 36 2/7 weeks
AOG by LMP,
cephalic in preterm labor
prelabor rupture of membranes for 30 mins
Procedure:
Primary low segment transverse cesarean
section for arrest of cervical dilatation
(6cm, 80% effaced, (-) BOW, cephalic,
station -2 for 4 hours)
Final Diagnosis
• G1 P1 Pregnancy Uterine term cephalic delivered via LSTCS
• live baby girl
• AS 6, 9
• AF thinly meconium stained
• BW 2800 g
• BL 49 cm
• MI 38 weeks AGA;
• prelabor rupture of membrane for 18 hours;
• young primiparity
COURSE IN THE WARD
• NPO
• D5LR x 8hrs
01-03-18 • Meds: Ampicillin 2g LD
-> 2g Q6 until delivery
3:35 A • Monitor FHT, VS q15
• For IUD insertion post
partum
COURSE IN THE WARD

• Shifter to PNSS 1L side

01-03-18 drip D5LR 1L + 10 ‘u’
12:00 oxytocin
COURSE IN THE WARD
• for ‘E’ CS + IUD
• D5LR 1L x 8hrs
01-03-18 • Cefuroxime 750g TIV
• For IUD insertion post
6pm
partum
COURSE IN THE WARD
• May transfer to RR
• NPO
• Meds: Cefuroxime 750 mg
01-03-18 IV
• Metronidazole 500g IV q8
10pm • Tramadol 50mg IV q8 x 4
doses
• Omeprazole 40mg IV
COURSE IN THE WARD
• To ward
• NPO temporarily; general
01-03-18
liquids at 11am (1-4-18)
10pm • Meds: Cefuroxime 500g
(+) uterus well TID x 7d
contracted • Mefenamic acid 500mg
(-) profuse vaginal Q6 PRN
bleeding • FeSO4 tab BID
• Conzace tab OD
COURSE IN THE WARD
• General liquids at 11am;
01-04-18 soft diet once with flatus;
DAT once with BM
10pm • For completion of IV
100/80; 19; 78; meds then shift to oral
38.1 meds
(-) F, (-) BM • May give paracetamol
NABS 300mg TIV
PRELABOR
RUPTURE OF
MEMBRANES
 “The disruption of fetal membranes before
thePreterm
beginning PROM: <37 weeks
of labor, resulting in
spontaneous leakage of amniotic fluid.”
Term PROM: >37 weeks

Endale T, Fentahun N, Gemada D, Hussen MA. Maternal and fetal outcomes in term premature rupture of membrane. World Journal of Emergency
Medicine. 2016;7(2):147-152. doi:10.5847/wjem.j.1920-8642.2016.02.011.
 RISK FACTORS
• 19- 29 yo (65/120)
• Primigravidity (52%)
• Nulliparity (56%)
• Genital tract infection
• previous preterm delivery

Mishra, S., & Mamta, J. (2017). Premature Rupture of Membrane- Risk Factors: A Clinical Study. International Journal of Contemporary Medical
Research,4(1), 77-83. Retrieved January 10, 2018, from https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1203_feb_4.pdf.
Delivery is indicated if:
• gestational age is ≥ 34 wk
• (+) infection
• (+) fetal compromise regardless of gestational
age.
Symptoms and Signs
• leakage or a sudden gush of fluid from the
vagina.
Diagnosis
Vaginal pooling of amniotic fluid:
◦ ferning or alkalinity (blue color) on Nitrazine paper

Ultrasound-guided amniocentesis with

dye for confirmation
Non-spontaneous delivery:
• fetal compromise
• Infection
• gestational age > 34 wk
Induction of labor is recommended when
gestational age is > 34 wk.
 CS in PROM
• Failed induction (50%)
• Macrosomia
• previous scars
• drained liquor (11.8%)
• previous C/S
• Breech
Gahwagi M, S., & Busarira, M. (2015). Premature rupture of membranes characteristics, determinants, and outcomes of in
Benghazi, Libya. Open Journal of Obstetrics and Gynecology,5(1), 494-504. Retrieved January 10, 2018
CS in PROM
The commonest indications were fetal distress (36.2%),
cephalopevic disproportion (25.8%) and fetal position
abnormality (14.1%).
 MATERNAL OUTCOME
• Chorioamnionitis (11.9%)
• Febrile morbidity (10.5%)
• Wound infection (1.4%)
•Puerperal sepsis (1.4%)
• LRTI (0.5%)
Jaiswal, A. A., Hariharan, C., & Dewani, D. K. (2017). Study of maternal and fetal outcomes in premature rupture of membrane in central rural
India. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology,6(4), 1409-1412. Retrieved January 4, 2018.
 FETAL OUTCOME
• Neonatal infection (23.8%)
• Birth asphyxia (6.19%)
• Late onset sepsis (0.95%)
• Congenital malformations (0.48)
• Congenital pneumonia (0.48)
• Perinatal mortality (1.43%)
Jaiswal, A. A., Hariharan, C., & Dewani, D. K. (2017). Study of maternal and fetal outcomes in premature rupture of membrane in central rural
India. International Journal of Reproduction, Contraception, Obstetrics and Gynaecology,6(4), 1409-1412. Retrieved January 4, 2018.
Thank you