PRROM

Question 1

PPROM definition

Answer 1

breakage of the amniotic sac before the onset of labor

Question 2

PPROM increases risk of

Answer 2

1. Chorioamnionitis

Question 3

Chorioamnionitis

Answer 3

Inflammation of the amnion and chorion due to bacterial infection
- caused by bacteria ascending from gaina into uterus

Question 4

Symptom of PPROM

Answer 4

1. Gush

2. Constant trick;le or dampness

Question 5

Symptoms of chorioamnionitis

Answer 5

1. Fever + Malaise
2. Abdominal pain
3. Purulent/offensive discharge

Question 6

Examination of chorioamnionitis

Answer 6

1. Maternal pyrexia and tachycardia
2. Uterine tenderness
3. Fetal tachycardia

Question 7

Speculum in Chorioamnionitis shows;

Answer 7

Offensive vaginal discharge - yellow/brown

Question 8

Ix of PPROM

Answer 8

1. FBC and CRP - raised WCC and CRP indicate infection
2. Swabs of vagina
3. MSY

Question 9

What examination must you not do in suspected chorioamnionitis

Answer 9

VAGINAL EXAM AS THIS INCREASES THE RISK OF INTRODUCING INFECTION

Question 10

Management of PPROM depends on;

Answer 10

If caused by chorioamnioitis or not

Question 11

PPROM caused by infection

Answer 11

1. Steroids
2. Deliver whatever gestation
3. Broad spectrum antibiotic cover

Question 12

PPROM not caused by infection

Answer 12

1. Admit
2. Give steroids
3. Give antibiotics - erythromycin

Question 13

Risks to fetus from PPROM

Answer 13

1. Prematurity
2. Infection
3. Pulmonary Hypoplasia
4. Limb contractures

Question 14

What is the principal issue with preterm prelabour rupture of the membrane?

Answer 14

Sepsis of both the mother and the fetus.

Question 15

How do you manage a patient with preterm prelabour rupture of the membrane?

Answer 15

Check fetal lie and presentation - risk of cord prolapse

Digital examination should not be done - unless there are obvious signs of labour - due to risk of infection introduction

Check for symptoms of clinical chorioamnionitis (fever, rigors, green or brown or foul smelling vaginal loss, tender uterus on palpation)

CTG

Blood tests

Administration of prophylactic erythromycin / treat sepsis

Administration of corticosteroids to improve fetal lung maturity

Question 16

What tocolytics are used in women with PPROM?

Answer 16

None. They are never used.

Question 17

What antibiotics should be avoid in someone with PPROM due to their association with necrotising enterocolitis in the infant?

Answer 17

Co-amoxiclav