QuestionSBA
QuestionChoice
Tocolytic agents (such as nifedipine) are used in pre-term labour in order to buy time so that steroids can be administered to encourage foetal lung maturation. The patient is not in labour as evidenced by the CTG showing no contractions, meaning tocolysis is not indicated.
10017300
e
Tocolytic agents
QuestionChoice
There are no current indications for an elective caesarean, such as malpresentation or placenta praevia. Elective caesarean sections often are planned at 39 weeks. An emergency caesarean section may be indicated if there are features of foetal distress.
10017299
d
Elective caesarean section at 36 weeks
QuestionChoice
IV benzylpenicillin may be used if the woman is in established labour and is febrile (material sepsis), or during delivery if there is a history of group B streptococcus colonisation. While antibiotics are required, oral erythromycin is the first choice for PPROM.
10017298
c
Intravenous benzylpenicillin
QuestionChoice
This is not appropriate. There are no features of foetal distress. Inducing labour this early poses risks to the foetus.
10017297
b
Immediate induction of labour
QuestionChoice
This patient has experienced a pre-term premature rupture of membranes. RCOG guidelines suggest antibiotics (preferably erythromycin) should be given for 10 days or until the woman is in established labour (whichever is sooner). They also recommend steroids are given until 33 weeks' 6 days' gestation.
10017296
a
Erythromycin and steroids
Concept
Chapter

# Summary

Prelabour rupture of membranes at term (PROM at term) is a condition where the amniotic membranes rupture prior to the onset of labour after 37 weeks of gestation. Key signs and symptoms include foul-smelling or greenish amniotic fluid, maternal fever, and reduced foetal movements. Investigations should focus on assessing signs of infection and foetal distress. The primary management strategy is to induce labour if it does not commence spontaneously within 24 hours of PROM. If signs of infection or foetal compromise are evident, immediate induction of labour or a caesarean section may be necessary under specialist guidance. Following delivery, mother and baby should be closely monitored for 12 hours.


# Definition



Prelabour rupture of membranes at term (PROM at term) is a condition characterized by the rupture of the amniotic membranes before the onset of labour after 37 weeks gestation. This condition is associated with increased risks of chorioamnionitis and neonatal infection.


# Epidemiology



PROM at term is a common obstetric complication, affecting approximately 8% to 10% of pregnancies. Most women with PROM at term will start spontaneous labour within the subsequent 24 hours.


# Aetiology



The exact cause of PROM is not well understood; however, it is believed to be due to a combination of factors including infection, inflammation, stress, and mechanical forces.


# Signs and Symptoms



Women with PROM at term may experience the following signs and symptoms:

- Foul-smelling or greenish amniotic fluid
- Maternal fever
- Reduced foetal movements

Digital vaginal examination should be avoided in the absence of labour. The foetal heart should be monitored.


# Differential Diagnosis



The main differentials for PROM include:

- Urinary incontinence: This can be distinguished by the absence of amniotic fluid and the presence of urinary symptoms.
- Vaginal discharge or infection: This can be ruled out by the absence of foul-smelling or greenish discharge and the absence of other infection symptoms.

# Investigations


Investigations for PROM should focus on assessing signs of infection and foetal distress, including:

- Monitoring maternal temperature
- Assessing foetal movements
- Monitoring foetal heart rate
- Observing vaginal discharge

# Management


Management of PROM at term involves the following steps:

- If labour does not commence within 24 hours, induction of labour should be offered.
- If there are any signs of infection, immediate induction of labour should be commenced under consultant guidance and a broad spectrum antibiotic should be given.
- If there are any signs of foetal compromise, senior review is required to make a decision about whether immediate caesarean section is required.
- Following delivery, even if both baby and mother are asymptomatic, they should be closely observed in hospital for 12 hours post-birth.

# Complications

PROM at term can lead to several complications, including:

- Chorioamnionitis due to ascending infection
- Preterm birth and the associated complications such as respiratory distress syndrome, necrotising enterocolitis, and foetal death
- Developmental problems such as pulmonary hypoplasia, facial and limb deformities due to compression in the uterus, and cord prolapse due to low levels of amniotic fluid.
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Pre-labour rupture of membranes at term
Topic
38
Obstetrics
16003
In cases of preterm prelabor rupture of membranes (PPROM), erythromycin is often given as an antibiotic prophylaxis to reduce the risk of infection, while steroids are administered to accelerate fetal lung maturation and reduce the risk of lung complications related to prematurity.
A 34-year-old primigravida attends hosptial after her membranes have ruptured at 32 weeks. Her medical history is unremarkable. A CTG shows no contractions and no features of foetal distress.

What is the most appropriate management?
a