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Preterm Premature Rupture Of MembranesAbdullatiff Sami Al-RashedBlock 4.3 (Life Cycle III)College of Medicine, King Faisal University Al-Asha, Saudi Arabia

+Definition

PPROM is rupture of fetal membranes prior to 37 weeks’ gestation.

It is a leading cause of neonatal morbidity and mortality and is associated with approximately 30% of preterm deliveries.

+Etiology & Risk Factors

Intrauterine infection

STDs Prior PPROM

Smoking(risk of

PPROM is doubled in mothers

who smoke during

pregnancy)

Multiple Gestation

Other

+Signs & Symptoms

Other symptoms includes flecks of meconium in the fluid, decrease in the size

of the uterus or change in color and consistency of fluid coming out of the

vagina.

The main symptom is sudden painless gush of fluid leaks out of the vagina or a steady leakage of small amounts of watery fluid.

+Diagnosis

1. A sterile speculum examination is first performed to evaluate the fetal membrane status and to inspect the cervix:

Membrane rupture is confirmed by visualization of amniotic fluid in the posterior fornix or by passing of amniotic fluid from the cervical canal.

+Diagnosis

2. Nitrazine Test: The nitrazine test uses pH to distinguish amniotic fluid

from urine and vaginal secretions.

Amniotic fluid is alkaline, having a pH above 7.1; vaginal secretions have a pH of 4.5 to 6.0, and urine has a pH of ≤6.0.

To perform the nitrazine test, a sample of fluid obtained from the vagina during a speculum examination is placed on a strip of paper or swab impregnated with nitrazine. If the pH is 7.1 to 7.3, reflecting that of amniotic fluid, the paper or swab turns dark blue.

+Diagnosis

Once membrane rupture has been confirmed, digital

examination of the cervix SHOULD BE AVOIDED until labor

or induction of labor.

+Diagnosis

3. Endocervical samples may be considered for gonorrhea and chlamydia testing if clinically indicated.

4. Group B streptococcus cultures are obtained.

+Diagnosis

5. Fetal heart rate and uterine activity monitoring are used to assess fetal well-being and uterine contraction pattern.

+Diagnosis

6. Ultrasound: Ultrasonography can be helpful in evaluating the possibility

of rupture of membranes.

If ample amniotic fluid around the fetus is visible on ultrasound examination, the diagnosis of PROM must be questioned.

+Differential Diagnosis

The differential diagnoses for PROM include:

Urinary incontinence

Increased vaginal secretions in pregnancy (physiologic)

Infections

Exogenous fluids (such as semen or douche).

+Complications

+Management

+References

Thank You

AL-AHSA