By Intern Dr. Borhan Uddin.

 Definition- Spontaneous rupture of the membrane any

time after the age of viability but before the onset of
labor is called premature rupture of membrane.
 Incidence of PROM- 10% of all pregnancy.
 Causes of PROM-Exact cause is not known-
Obstetrical cause-
1. Multiple pregnancy.
2. Polyhydramnios
3. Malpresentation and contracted pelvis
Maternal infection-
1. UTI .
2. Lower genital tract infection.
3. Chorioamnionitis.
4. Cervical incompetence.
5. Frequent coitus in last month
 Diagnosis of PROM-
a) History.
b) Examination
c) Investigation.
 History- Sudden escape of watery discharge per vagina either
in the form of gush or slow leak.
 Examination-If chorioamnionitis is developed then sign of
infection.
1) Fever.
2) Tachycardia.
3) Uterine tenderness.
4) Foul smelling discharge.
 Confirmation of diagnosis- Sterile speculum examination
shows liquor escaping out through the cervix and then
examine the fluid.
 How we confirm that it is liquor or other fluid?

 Detection of PH by litmus or nitrazine paper- Normal vaginal

PH is -4.5-5.5.If it is liquor then PH-7-7.5.
 Fern test- Fluid from posterior fornix is placed on a slide and
allowed to dry. Amniotic fluid from a fern like pattern of
crystallization.
 Nitrazine test- a sterile cotton tipped swab should be used to
collect fluid from posterior fornix and apply it to nitrazine
paper. If it is amniotic fluid then the paper turns into blue.
 Hydrorrhoea gravidarum.
 Incontinence of urine especially in later month.
 Investigations-
 CBC-Neutrophilic leukocytosis in case of chorioamnionitis.
 Urine for R/E.
 High vaginal swab for culture and sensitivity test.
 USG for monitoring the fetal well -being.
 To start prophylactic antibiotics-
 Need To asses gestational age.
 Patient not in labor.
 Absence of infection and fetal distress.
 Pregnancy more than 34 weeks- Wait for Pregnency more than 38 weeks- Wait for
Pregnancy less than 34 weeks – Expectant spontaneous onset of labor for 24-48 24 hours.
treatment and continue for fetal maturity. hours • If fails either induction or caesarean
Hospitalization. • If fails- section.
Bed rest. • Induction with oxytocin
sterile valval pad. • caesarean section
prophylactic antibiotic.
Maternal monitoring- pulse, BP, Temp,
uterine tenderness.
Fetal monitoring- FHR, USG, Biophysical
profile.
Injection- Dexamethasone 12 mg 2 dose
12 hourly ( 2.5 amp) which stimulate
type-2 alveolar cell and release surfactant
which prevent RDS.
 Maternal-
 preterm labor.
 Infection.
 Increase chance of cord prolapse.
 Prolong labor.

 Fetal –
 High perinatal mortality and morbidity.
 Neonatal infection.