Pprom & prom

1. Preterm premature rupture
of membrane (PPROM)
&
Premature rupture of
membrane (PROM)
By: Dr Ismah Haron
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2. Definition
• PPROM:
Amniotic membrane rupture before 37 completed weeks
• PROM:
Amniotic membrane rupture at or after 37 completed weeks
and not in labour yet
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3. Its importance
Associated with:
• Cord prolapse
• Maternal and neonatal infection
• 40% of preterm deliveries
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4. Diagnosis
• History
- Gushing of warm fluid, dribbling though thigh
• Examination
1. Per abdomen: uterus smaller than date, easily felt fetus parts
2. Per speculum: pooling of liquor at posterior fornix (color, smell)
3. Cough test
• Others
1. Ultrasound: oligohydramnios
2. Special tests: litmus, ferning and nitrazine test
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5. 5
ferning
nitrazine
litmus

6. Management
• HVS, FBC
• PPROM
- Antibiotic: erythromycin X10/7
Neonatal infection was significantly reduced in the
babies whose mothers received antibiotics (RR 0.68; 95% CI 0.53–0.87).
- IM Dexamethasone 12 mg 12 hrs apart X1/7
- Ventilator support
- Mode of delivery
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7. • PROM
- Clear liquor
Allow labour, induced
- Meconium stained liquor  pitocin/EM LSCS
- IV Ampicillin 2 g stat & 1 g QID
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8. Chorioamnionitis
• Maternal
- Pyrexia
- Tachycardia
- Leukocytosis
- Uterine tenderness
• Fetal
- Tachycardia
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9. • Management
- Delivery
- IV Cefuroxime & IV Metronidazole
- Inform pediatric team
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10. References
• Preterm Prelabour Rupture of Membranes. November 2006 (Minor
amendment October 2010). RCOG Green-top Guideline No. 44
• Term Prelabour Rupture of Membranes (Term PROM). C-Obs 36,
1st Endorsed: July 2010, Current: July 2010, Review: July 2013.
The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists
• A Practical Approach To Obstetric Problems 3rd edition by Prof
Kulenthran Arumugam
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11. THANK YOU
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