What is the definition of PPROM?
Premature Prolonged Rupture of Membranes - SROM before 37/40 and before the onset of labour
What are some complications of PPROM?
- Prematurity
- Sepsis
- Pulmonary hypoplasia
- Cord prolapse
- Malpresentation
- APH
What is pulmonary hypoplasia?
Low number/size of alveoli in the lungs
How is PPROM most commonly diagnosed?
- Pool of fluid seen in vagina during speculum examination
- Make women lie down for 1/2 hour before examination to allow liquid to pool
What are some other ways that PPROM is diagnosed?
- Nitrazine test
- Microscopic examination
- USS for oligohydramnios
Why is the Nitrazine test not reliable?
It is a pH test that also indicates vaginal secretions, semen and blood
What does the microscopic examination look for?
- Ferning of crystalline pattern of dried amniotic fluid
- Presence of lanugo hair
- Foetal epithelial cells
What else may these women present with?
- Abdo pain
- Back pain
- Bleeding
How is PPROM managed?
- Corticosteroids
- Antibiotics
- ?Timing and method of delivery
- Inpatient vs. home care
What is the most common antibiotic used and what is given if the woman is unable to tolerate this?
- Erythromycin 250mg QDS for 10 days/ until labour begins
- Unable to tolerate = Penicillin
Which antibiotics should not be given and why?
Augmentin and Co-Amoxiclav as they increase the risk of NEC
How does inpatient management work?
- Temp 4 hourly
- CTG, CRP and WCC daily
- USS for liquor, growth and Doppler
- MSU and HVS/LVS
- ?Discharge after 48 hours
How does home management work?
- Temp QDS (to report if abnormal)
- Twice weekly review for CTG, CRP, WCC
- Fortnightly USS for growth
- Weekly USS for Doppler
- No baths, sex or tampons
- Given info regarding signs/symptoms to look for
What are the advantages of home management?
- Approx. 10 fewer hospital days as an inpatient
- Decreased cost
- Psychological benefit
- Less danger of infection
What are the disadvantages of home management?
- Deterioration may be missed
- Foetal monitoring only twice weekly
What is an amnioinfusion?
The process of installing isotonic liquid into the uterine cavity
