Prelabour Rupture of Membranes (PROM)

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It is the rupture of membranes (breakage of the amniotic sac) before the onset of labor. If rupture  occurs before 37weeks it is called preterm prelabour rupture of membranes (PPROM). Prolonged PROM is a case of premature rupture of membranes in which more than 24 hours have passed  between the rupture and the onset of labour. Prolonged PROM for more than 18 hours is a risk of  ascending infection which can lead to chorioamnionitis (infection of chorion, amnion and amniotic  fluid. 

Clinical presentation

Leakage of watery fluid per vagina confirmed by performing a sterile speculum examination. 

Management of PROM at the dispensary and health center 

Give the following antibiotics for prophylaxis against chorioamnionitis 

A: erythromycin (PO) 500mg 8hourly for 7days 

AND 

A: metronidazole (PO) 400mg 8hourly for 7days 

Referral: Refer to the hospital for further evaluation and management 

Management of PROM at the hospital 

Investigations 

  • Ultrasound for fetal wellbeing, amount of liquor and gestation age
  • Perform a sterile speculum examination to confirm leakage
  • Perform HVS for culture and susceptibility testing
  • Urinalysis

General Management 

If PROM at term: Delivery within 24 hours 

Assess Bishop’s Score and Induce Labour accordingly with 

A: misoprostol (PO) 25mcg 8hourly (Max 3doses) if unfavorable cervix  

OR  

A: oxytocin (IV) 5IU in 500ml of D5% titrate beginning with 10dpm if favourable cervix 

Monitor  FHR  vigilantly  during  the  process  of  IOL.  Deliver  by  C/S  if  vaginal  delivery  is  contraindicated, fetal distress or failed induction of labour. 

For Preterm PROM: 

If no sign of infection, wait for foetal maturity and give

B: dexamethasone (IM) 6mg 12hourly for 48 hours if pregnancy is ˂34weeks for fetal lung  maturation 

AND

B: nifedipine (PO) 20mg 8hourly for 7 days for tocolysis 

Monitor for infection (FBP, RCP, Pulse, Fever) and fetal wellbeing (fetal movement, FHR, obstetric ultrasound)

Administer prophylactic antibiotics

A: metronidazole (PO) 400mg 8hourly 10days

AND 

A: erythromycin (PO) 500mg 8hourly for 10days 

OR 

B: amoxicillin + clavulanic acid (FDC) (PO) 625mg 8hourly for 10days                      

Deliver irrespective of gestation age in case of infection 

If there are signs of infections-pyrexia, foul smelling liquor (chorioamnionitis) 

A: metronidazole (PO) 400mg 8hourly for 5-7 days  

AND 

C: amoxycillin + clavulanic acid (FDC) (IV) 1.2g 8hourly for 5-7days  

OR  

D: ceftriaxone + sulbactam (FDC) (IV) 1.5g 12hourly for 5-7 days