Prelabor rupture of membranes (PROM), or premature rupture of membranes, ............................................ is a condition that occurs in pregnancy when there is rupture of the membrane of the amniotic sac and chorion more than one hour before the onset of labor. PROM is considered prolonged when it occurs more than 18 hours before labor. PROM is considered preterm when it occurs before 37 weeks gestation, and is called Preterm Premature Rupture of Membranes (or PPROM) _PPROM occurs in about 1% of all pregnancies, and about 1/3 of preterm births are associated with PPROM. _Maternal risk factors for a premature rupture of membranes include chorioamnionitis or sepsis. Fetal factors include prematurity, infection, cord prolapse, malpresentation or genetic mutations. _Assessment of a rupture of membranes involves taking a proper medical history, a gynecological exam using a speculum, nitrazine, cytologic (ferning) tests, and ultrasound. Amniotic fluid, when dried for 10 minutes on a slide and then viewed under a microscope, shows a characteristic fernlike pattern. Cervical mucus can also show ferning, but the fern-like shapes are usually smaller. Assessment for rupture of membranes can also involve dipstick tests on fluid or discharge _Management of Prelabor rupture of membranes (PROM), or premature rupture of membranes,Preterm birth: Tocolysis is also sometimes used, though its use in this context is controversial. The mother should be admitted to hospital and put under careful surveillance for preterm labor and chorioamnionitis. Induction of labor should happen at around 34 weeks. Antenatal steroids if the gestational age is less than 32 weeks. Infection Maternal: If chorioamnionitis is present at the time of PPROM, antibiotic therapy is usually given to avoid sepsis, and delivery is indicated. If chorioamnionitis is not present, prompt antibiotic therapy can significantly delay delivery, giving the fetus crucial additional time to mature. In preterm premature rupture of membranes (PPROM), antibiotic therapy should be given to decrease the risk of sepsis. Ampicillin or erythromycin should be administered for 7 days Fetal: If the GBS status of the mother is not known, penicillin or other antibiotics may be administered for prophylaxis against vertical transmission of Group B streptococcal infection.
Posted on: Wed, 14 Aug 2013 04:30:26 +0000
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