Premature rupture of membranes (PROM) is the rupture of the membranes more than an hour before the onset of labor.Pre-term PROM in 2% of all pregnancies.Risk factors for pre-term PROM are Smoking,Previous pre-term delivery,Vaginal bleeding.
Do not do a vaginal inspection as this will increase the risk of ascending infection.Earliest clinical signs of ascending infection are fetal tachycardia and a mild increase in maternal temperature.
Women with pre-labour rupture of the membranes at term (over 37 weeks) should be offered a choice of immediate induction of labour or expectant management.
In Preterm PROM,administration of Tocolytics, e.g. atosiban, nifedipine or ritodrine, may delay delivery by 48 hours and therefore enable time for antenatal corticosteroids to be given. Antenatal steroids should be given if gestation is between 24 and 36 weeks. Dexamethasone accelerates fetal surfactant production and lung maturation. Antenatal steroids have been shown to reduce respiratory distress syndrome, intraventricular haemorrhage and mortality by 40%.
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.Co-amoxiclav should be avoided in women at risk of pre-term delivery because of the increased risk of neonatal necrotising enterocolitis.