The Generalist: Preterm Prelabor Rupture of Membranes (PPROM)
Ben Shepherd MD, Heidi James MD, and Vanessa Cardy MD
- PPROM is associated with significant perinatal morbidity and mortality including
- Preterm labor and birth (correlates with gestational age)
- Cord prolapse
- Intrauterine infection (chorioamnionitis)
- Placental abruption
- Pulmonary hypoplasia
- Limb positioning defects
- Adverse birth experience / lost income / PTSD
- Presents as PV fluid loss
- Diagnostic aids
- History
- Sterile speculum exam
- Formal US / Amniotic fluid index can be suggestive
- Admission for pad checks
- Al-sense (panty-liner)
- Discriminates on pH / main DDx is urine leak
- Ferning under microscope
- Nitrazine test - pH > 6 turns blue (pH amniotic fluid usually > 7)
- Management
- Confer with obstetrics
- Corticosteroids
- Betamethasone 11.4mg IM 24 hrs apart
- Dexamethasone
- Antibiotics
- Benzylpenicillin IV for 48hrs
- Oral erythromycin 250 mg QID for 10 days
- If evidence of chorioamnionitis: Ampicillin / Gentamicin / Metronidazole
- Tocolysis
- If contractions are present
- Oral nifedipine
- Neuroprotection
- MgSO4 infusion 4g, then 1g/hr
- Counselling regarding potential harms and benefits of management options
