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Chapter-05 Premature Rupture of Membranes

BOOK TITLE: Management of High-Risk Pregnancy—A Practical Approach

Author
1. Patra Sharda
ISBN
9789380704739
DOI
10.5005/jp/books/11228_5
Edition
1/e
Publishing Year
2010
Pages
14
Author Affiliations
Chapter keywords

Abstract

Premature rupture of membranes (PROM) complicates 5-10% of all pregnancies. Preterm PROM occurs in 2 to 4% of all pregnancies. The etiopathogenesis of PROM is still unknown; however, infection remains the major contributor in its genesis. The fetal membranes serve as a barrier to ascending infection. Once the membranes rupture, both the mother and fetus are at risk of infection and of other complications. The hallmark of diagnosis of PROM is history of leaking and direct visualization of pooling of amniotic fluid in the vagina or leakage of fluid from the cervical os on per speculum examination. Management of a woman presenting with suspected PROM includes confirming the diagnosis, documenting correct gestational age, assessing fetal well-being and deciding on the plan of management. Immediate termination of pregnancy irrespective of the gestational age should be the option in women with signs/symptoms suggestive of chorioamnionitis, signs of fetal distress and abruptio placentae. The management of term PROM includes administration of antibiotics and induction of labor. Expectant management should be the option in women with preterm PROM less than 34 weeks with no evidence of chorioamnionitis. The components of expectant management include admission to hospital, fetomaternal monitoring, administration of antenatal corticosteroids and prophylactic antibiotics. In the absence of fetal or maternal compromise, termination of pregnancy should be accomplished if pregnancy is more than 34 weeks.

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