PREMATURE RUPTURE OF
MEMBRANES (PROM)
Lin Qi De
Definition
PROM is defined as the rupture
of the chorioamniotic
membrane before the onset of
labor
Incidence
?PROM occurs in about
10%~15% of all delivery
?PROM is associated with
10% of term pregnancy
Cause of PROM
?Trauma (abdominal striked intensely)
?Sexual intercourse(particularly in the late
gestational weeks) ?
Vaginal infection
due to bacteria,virus,TOXO,CMV,HPV
and HSV,et al
? Smoking
?Other,
?Prior PROM
?A short cervical length
?Prior preterm delivery
?Bleeding in early pregancy
Affect of PROM on the
mothers and infants
Mothers,
(1) Infection, intrauterine
puerperal
(2) Placental abruption
(3) Preterm delivery
Infants,
(1) Preterm Baby and their Complications,
(RDS / Fetal and Neurologic dysfunction
Intracranial hemorrhage)
(2) neonatal pneumonia,sepsis
(3) Pulmonary hypoplasia and fetal
compression syndrone
(4) Prolapse or compression of umbilical cord
(5) Abruptio placenta
Clinical manifestation
(1) Fluid passing through the vagina suddenly,
and then small amounts of fluid flow
through the vagina intermitently,
particularly when the increased of
abdorminal pressure (cough,sneeze,et al)
(2) Free flowing amniotic fluid
(3) Fever / heart rate of mother and
infants ↑ / WBC and CRP ↑ / Uterine
tenderness on palpation
Diagnosis
(1) Vaginal speculum exam.,
leakage of amniotic fluid
(2) PH determination of vaginal fluid
(3) The,fern” test
(4) Aminoscopy
Management
PROM at term,
(1) Awaiting the onset of spontaneous labor for 12-24h
(2) Termination of pregnancy after 24 hours
PROM before term,
Termination of pregnancy
(1) Evidence of fetal pulmonary maturation
(2) Evidence of inturine infection
Expectant therapy
Indication,
(1) Evidence of fetal pulmonary inmaturation
(2) Without evidence of inturine infection
Management,
(1)To enhance fetal pulmonary maturation
(2) Antibiotic
(3) Tocolysis