Prolonged ROM

Question 1

What are the immediate risks of term prelabour ROM?

Answer 1

The immediate risks of rupture of membranes include:

• cord prolapse
• cord compression
• placental abruption.

Question 2

What are the delayed risks of prelabour ROM?

Answer 2

maternal and neonatal infection

Question 3

Active management of term PROM

Answer 3

• induction
• associated with reduced maternal infective morbidity and increased maternal satisfaction without increasing caesarean section or operative vaginal birth
• Fewer infants are admitted to NICU and fewer infants require postnatal antibiotics.
  
  • some women and/ or clinicians may reasonably elect for a short trial of expectant management (e.g. for up to 24/24) in highly selected and well supervised cases.

Question 4

Criteria for expectant management of prelabour ROM

Answer 4

• Term PROM with fixed cephalic presentation.
• Group B streptococcus (GBS) negative.
• No signs infection (maternal tachycardia, fever, uterine tenderness).
• Normal CTG.
• No history of digital vaginal exam, cervical suture.
• Adequate resource/staffing to provide support as an outpatient or inpatient.
• Commitment to 4 hourly maternal temperature, evaluation of vaginal loss and assessment of fetal well-being

Question 5

What is the role of antibioitcs in term PROM?

Answer 5

• Women who are known to be GBS positive
• In women known to have vaginal Group B streptococcus (GBS) colonisation, prophylactic antibiotics and early administration of oxytocin is recommended.

Question 6

In what situations is intrapartum antibiotic prophylaxis indicated?

Answer 6

• GBS identified by the results of screening cultures from either vaginal or rectal swabs in late gestation during the current pregnancy invasive GBS disease in a neonate from a previous pregnancy
• GBS bacteriuria detected during any trimester of the current pregnancy
• unknown antepartum GBS status (cultures not performed, results incomplete or not available) and any of the following:
  
  • intrapartum fever (38ºC or more)
  • preterm onset of labour (before 37 weeks’ gestation)
  • prolonged rupture of membranes (18 hours or longer)
  • intrapartum nucleic acid amplification test (NAAT) positive for GBS.

Question 7

Which Abx are used in intrapartum prophylaxis?

Answer 7

• benzylpenicillin 3 g IV, for the first dose, then 1.8 g IV, 4-hourly until delivery

For patients sensitive to penicilins

• cephazolin