Term Prelabour Rupture of Membranes (Term PROM)

Last updated 25.08.13

 

 Definition

-  Rupture of membranes >37 weeks gestation of pregnancy & prior to onset of labour

 

Features

-  Clinical Dx

-  60% women go into labour by 24hrs

 

Associated S/S

-  Sensation of passing water from vagina

-  Wet pads/underwear

-  Signs of infection

-  Fever

-  Abdo pain

-  Nausea, vomiting

 

Ix

-  Vitals

-  Temp: Fever: infection

-  Abdo palp

-  Contractions: labour

-  Position, lie: as relevant to labour

-  Uterine tenderness: chorioamnionitis

-  Fundal height

-  +/- Speculum exam

-  Lying speculum: >20min supine

-  May see obvious liquor: MSL, clear, pink

-  Ask pt to cough: stream from cervix

-  If Hx > few days may not expect to see liquor

-  Vagina may only appear clean/washed out indicating SROM

-  +/- HVS & LVS for MCS: GBS status

-  +/- Amnisure

-  DO NOT perform VE

-  Risk of infection: chorioamionitis

-  Unless required to assess labour

-  CTG 20min+

-  +/- FBE & G&H

-  +/- US

-  Reduced AFI with normal kidneys & nil IUGR = highly suggestive

-  Normal AFI does not exclude PROM

 

Mx

-  Liquor evident at introitus

-  If contracting

-  Admission for confirmed SROM

-  No need for Spec exam

-  VE if needed to assess progress of labour

-  Mx of labour

-  Not contracting

-  Spec exam for HVS

-   + LVS if GBS unknown

-  Admission vs Expectant Mx (see below)

-  Liquor NOT evident at introitus

-  Spec exam as per Ix of ruptured membranes

-  20min+ supine prior to R/V

-  If liquor seen Mx as per above (liquor evident)

-  If liquor not seen

-   D/C home unless suspicious

-   +/- prudent use of Amnisure

-   If suspicious or strong Hx consider US

Cases of confirmed ROM

-  +/- FBE, CRP as baseline

-  Admission

-  Indicated if

-   Fever >37oC

-   Maternal of foetal tachycardia

-   MSL

-   Offensive vaginal discharge

-   GBS positive

-   Active genetial herpes

-   Known HIV

-   Breech or abnormal lie

-   High head

-   Poor obs Hx

-   Maternal issues: anxiety, transport, language..

-  OR Expectant Mx

-  D/C home to establish labour for max 72hrs

-  Book for IOL at next available (max 72hrs)

-  Home monitoring

-   4/24 temps

-  >37.1oC Paracetamol

-  Then recheck in 1hr if >37.1oC hospital R/V

-   PV loss for change in color or odour

-   Foetal movements

-  R/V in clinic/hospital each 24hrs

-  Avoid intercourse: increased risk of infection

-  Bath & shower OK

Antibiotics for GBS in labour

-  Indicated if

-  GBS unknown & >18/24

-  Known GBS positive

-  GBS negative not needed

-  PO Abx not indicated prior to labour

   

 

 

References

 

LRH: Mx of PPROM Protocol