Obstetric Emergencies
Premature rupture of membranes (PROM) is the spontaneous rupture of the amniotic sac before the onset of labor. It occurs in 8–10% of pregnancies and is a major cause of preterm birth and neonatal complications.
Definition & Types
- Term PROM: ≥37 weeks, before labor
- PPROM: <37 weeks
- Prolonged ROM: >18h → ↑ infection risk
Normal Physiology
Amniotic fluid: cushioning, temperature, sterile barrier.
Premature loss → loss of protection → ↑ risk of infection, cord prolapse, prematurity.
Etiology
Infectious
- BV, Chlamydia, Gonorrhea
- Chorioamnionitis
- Subclinical infection
Non-Infectious
- Polyhydramnios, twins
- Cervical incompetence
- Trauma, smoking
Pathophysiology
Infection/inflammation → collagen breakdown → weakened membranes → rupture under pressure.
Post-rupture: fluid leak → bacterial ascent → fetal risk.
Clinical Features
Symptoms
- Gush or trickle of clear fluid
- Wetness, reduced movements
- No pain
Signs
- Pooling on speculum
- Leak with cough
Diagnosis
| Test | Result |
|---|---|
| Nitrazine | pH >6.5 (blue) |
| Fern test | Ferning pattern |
| Amnisure | Placental proteins |
Avoid digital exam. Use ultrasound for AFI.
Management by Gestational Age
| GA | Management |
|---|---|
| ≥37w | Induce within 24h + antibiotics |
| 34–37w | Induce (infection > prematurity risk) |
| 24–34w | Conservative: steroids + antibiotics |
| <24w | Counsel — poor prognosis |
Medications
- Antibiotics: Ampicillin 2g IV q6h ×48h → Amox + Eryth PO
- Steroids: Betamethasone 12mg IM ×2
- Infection: Immediate delivery + broad-spectrum Abx
Key Takeaways
- PPROM = <37w, major preterm cause
- Diagnosis: pooling + nitrazine/fern
- Avoid digital exams
- Term: induce + Abx
- Preterm: steroids + Abx + monitor
- Infection → deliver immediately
Conclusion
PROM requires rapid diagnosis and gestational-age-specific management. Early intervention prevents infection and prematurity complications.
PROM is a race between infection and fetal maturity.