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Preterm premature rupture
of membrane (PPROM)
&
Premature rupture of
membrane (PROM)
By: Dr Ismah Haron
1
Definition
• PPROM:
Amniotic membrane rupture before 37 completed weeks
• PROM:
Amniotic membrane rupture at or after 37 c...
Its importance
Associated with:
• Cord prolapse
• Maternal and neonatal infection
• 40% of preterm deliveries
3
Diagnosis
• History
- Gushing of warm fluid, dribbling though thigh
• Examination
1. Per abdomen: uterus smaller than date...
5
ferning
nitrazine
litmus
Management
• HVS, FBC
• PPROM
- Antibiotic: erythromycin X10/7
Neonatal infection was significantly reduced in the
babies ...
• PROM
- Clear liquor
Allow labour, induced
- Meconium stained liquor  pitocin/EM LSCS
- IV Ampicillin 2 g stat & 1 g QID...
Chorioamnionitis
• Maternal
- Pyrexia
- Tachycardia
- Leukocytosis
- Uterine tenderness
• Fetal
- Tachycardia
8
• Management
- Delivery
- IV Cefuroxime & IV Metronidazole
- Inform pediatric team
9
References
• Preterm Prelabour Rupture of Membranes. November 2006 (Minor
amendment October 2010). RCOG Green-top Guidelin...
THANK YOU
11
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Pprom & prom

  1. 1. Preterm premature rupture of membrane (PPROM) & Premature rupture of membrane (PROM) By: Dr Ismah Haron 1
  2. 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 2
  3. 3. Its importance Associated with: • Cord prolapse • Maternal and neonatal infection • 40% of preterm deliveries 3
  4. 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 4
  5. 5. 5 ferning nitrazine litmus
  6. 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 6
  7. 7. • PROM - Clear liquor Allow labour, induced - Meconium stained liquor  pitocin/EM LSCS - IV Ampicillin 2 g stat & 1 g QID 7
  8. 8. Chorioamnionitis • Maternal - Pyrexia - Tachycardia - Leukocytosis - Uterine tenderness • Fetal - Tachycardia 8
  9. 9. • Management - Delivery - IV Cefuroxime & IV Metronidazole - Inform pediatric team 9
  10. 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 10
  11. 11. THANK YOU 11
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