17.

Premature Rupture of
Membranes (PROM)
Study Session 17 Premature Rupture of Membranes (PROM).....................................3
Introduction................................................................................................................3
Learning Outcomes for Study Session 17..................................................................3
17.1 Premature rupture of membranes......................................................................3
17. !"assifications of PROM...................................................................................#
17.3 Ris$ factors for PROM......................................................................................#
17.3.1 Infection can cause PROM.........................................................................%
&o' 17.1 ()idence of infection in a *oman *it+ PROM.....................................%
17.3. Ma"presentation of t+e fetus.......................................................................%
17.3.3 Mu"tip"e pregnancy and e'cess amniotic f"uid...........................................%
17.3.# !er)ica" incompetence...............................................................................%
17.3.% ,rauma to t+e abdomen..............................................................................-
17.# .iagnosis of PROM..........................................................................................-
&o' 17.1 !"inica" features of PROM....................................................................-
17.% !omp"ications of PROM...................................................................................7
17.%.1 Infection after PROM.................................................................................7
/uestion.................................................................................................................7
0ns*er...................................................................................................................7
17.%. !ord pro"apse.............................................................................................7
17.%.3 1eta" +ypo'ia and asp+y'ia........................................................................2
17.%.# P"acenta" abruption.....................................................................................2
1
17.%.% Preterm "abour............................................................................................2
17.%.- .eformity of feta" "imbs.............................................................................2
17.- 0ctions in a case of PROM.............................................................................13
17.-.1 4+en s+ou"d you conduct t+e de"i)ery before referra"5..........................13
/uestion...............................................................................................................13
0ns*er.................................................................................................................13
17.-. 4+en s+ou"d you refer before conducting t+e de"i)ery5..........................11
Summary of Study Session 17.................................................................................1
Se"f60ssessment /uestions (S0/s) for Study Session 17.......................................1
S0/ 17.1 (tests Learning Outcomes 17.1 and 17.)...........................................13
0ns*er.................................................................................................................13
S0/ 17. (tests Learning Outcomes 17.17 17.37 17.# and 17.%).........................13
0ns*er.................................................................................................................1#
!ase Study 17.1 8ufan9s story............................................................................1#
S0/ 17.3 (tests Learning Outcomes 17.17 17.7 17.% and 17.-).........................1#
0ns*er.................................................................................................................1#

Study Session 17 Premature Rupture of

Membranes (PROM)
Introduction
In t+is study session you *i"" "earn t+e definition7 c"assification and ris$ factors of
premature rupture of membranes (PROM). 4e *i"" describe t+e potentia"
comp"ications t+at may end up *it+ serious materna" morbidity and7 at t+e *orst7
materna" morta"ity.
,+is session a"so te""s you about t+e potentia" comp"ications t+at endanger t+e "ife of
t+e fetus and t+e ne*born baby. :ou *i"" "earn +o* to ma$e a c"inica" diagnosis of
PROM and *+at actions you can ta$e *+en you +a)e *omen *it+ PROM7 bui"ding
on your e'isting $no*"edge about "ea$age of f"uid from t+e )agina as one of t+e
danger symptoms in Study Session 1%.
Learning Outcomes for Study Session 17
4+en you +a)e studied t+is session7 you s+ou"d be ab"e to;
17.1 .efine and use correct"y a"" of t+e $ey *ords printed in bold.
(S0/ 17.17 17. and 17.3)
17. .escribe t+e c"assification of PROM. (S0/ 17.1 and 17.3)
17.3 .escribe t+e different ris$ factors associated *it+ PROM. (S0/ 17.)
17.# .efine t+e diagnostic features of PROM. (S0/ 17.)
17.% .iscuss t+e possib"e comp"ications of PROM affecting t+e mot+er and t+e fetus.
(S0/ 17. and 17.3)
17.- ('p"ain *+at action you need to underta$e *+ene)er you come across a *oman
*it+ PROM. (S0/ 17. and 17.3)
17.1 Premature rupture of membranes
Premature rupture of membranes (PROM) is defined as a spontaneous "ea$age of
amniotic f"uid from t+e amniotic sac *+ere t+e baby s*ims< t+e f"uid escapes t+roug+
ruptured feta" membranes7 occurring after = *ee$s of gestation and at "east one +our
before t+e onset of true "abour. PROM can occur before or after #3 *ee$s9 gestation7
so t+e *ord >premature9 does not mean t+at t+e gestationa" age of t+e fetus is preterm.
Premature +ere refers to t+e premature rupture of feta" membranes before t+e onset of
"abour. PROM is of concern because rupture of feta" membranes before t+e onset of
"abour is not norma" and is associated *it+ many comp"ications (described "ater in t+is
3
session). In a norma" "abour7 t+e feta" membranes usua""y rupture after t+e "abour +as
progressed for some time7 *+en t+e feta" +ead is deep"y engaged and t+e cer)i' is
near to fu"" di"atation7 *it+ no comp"ications in most "abouring *omen. (:ou *i""
"earn in detai" about "abour progress in t+e ne't Modu"e7 Labour and Delivery Care.)
:ou need to $no* t+at t+e ma?ority of peop"e in (t+iopia don9t t+in$ of PROM as a
prob"em. Rat+er7 t+ey consider t+e "ea$age of f"uid as a good symptom about t+e
coming "abour. 0s you *i"" see "ater in t+is study session7 many serious comp"ications
can occur as a resu"t of PROM. ,+erefore7 you need to counse" t+e *oman7 +er
+usband@partner and +er fami"y )ery c"ear"y about t+e actions t+ey s+ou"d ta$e if +er
membranes rupture and f"uid "ea$s from +er )agina before "abour begins. ,e"" t+em
about t+e dangers of *aiting at +ome after t+e rupture of feta" membranes. 4e begin
by describing +o* you c"assify cases of PROM7 *+ic+ determines +o* you +and"e
eac+ case.
17. !lassifications of PROM
PROM is c"assified according to t+e gestationa" age at *+ic+ it occurs and t+e inter)a"
bet*een rupture of t+e feta" membranes and t+e onset of true "abour.
Preterm PROM occurs after = *ee$s of gestationa" age and before 37 *ee$s.
"erm PROM occurs after 37 comp"eted *ee$s of gestationa" age7 inc"uding post6
term cases occurring after #3 *ee$s.
Preterm and term PROM are furt+er di)ided into;
#arly PROM ("ess t+an 1 +ours +as passed since t+e rupture of feta"
membranes)
Prolonged PROM (1 or more +ours +as passed since t+e rupture of feta"
membranes).
,+e ma?or reason for c"assifying PROM into term7 preterm7 ear"y and pro"onged
PROM is for effecti)e management decisions. ,+e earlier t+e occurrence (preterm
PROM) and t+e longer t+e inter)a" bet*een t+e rupture of feta" membranes and onset
of "abour7 t+e more comp"ications t+ere are "i$e"y to be. 4e *i"" describe t+e actions
you s+ou"d ta$e to manage cases of PROM in Section 17.- of t+is study session. 1irst7
*e discuss t+e ris$ factors for PROM and t+en t+e comp"ications t+at can resu"t for
t+e mot+er and t+e fetus.
17.$ Ris% factors for PROM
Rupture of feta" membranes can occur *+en t+e cer)i' is eit+er c"osed or di"ated.
Sometimes7 it can occur in a )ery ear"y pregnancy (before = *ee$s A t+is "eads to
ine)itab"e abortion7 *+ic+ you *i"" "earn about in Study Session 3)7 or in ear"y t+ird
trimester (bet*een = and 3# *ee$s). It is not e'act"y $no*n *+y feta" membranes
rupture before t+e onset of "abour. Bo*e)er7 t+ere are some $no*n ris$ factors +ig+"y
associated *it+ PROM.
#
!onsider t+e amniotic ca)ity as a sac (or bag) *+ose *a"" is formed by t+e feta"
membranes7 enc"osing t+e fetus and amniotic f"uid. ,+e sac *i"" rupture at t+e *ea$est
point7 *+ic+ is t+e part of t+e membranes in direct contact *it+ t+e >mout+9 of t+e
cer)i'. Rupture +appens *+en t+e sac is eit+er damaged by an infection or e'terna"
trauma7 or it becomes o)er6stretc+ed (distended) and unab"e to *it+stand t+e interna"
pressure. ,+ese ris$ factors are described in more detai" be"o*.
17.$.1 Infection can cause PROM
&acteria t+at cause infection in t+e "o*er genita" tract (infection of t+e cer)i' or
)agina" *a"") can tra)e" up*ards t+roug+ t+e cer)i' and infect t+e feta" membranes.
,+is can *ea$en t+e membranes enoug+ to a""o* t+em to rupture.
&o' 17.1 summarises t+e diagnostic signs of infection in a *oman *it+ PROM.
&o' 17.1 #(idence of infection in a )oman )it* PROM
1e)er; t+e *oman may comp"ain of fee"ing fe)eris+7 or you may record +er
temperature of 3=C! or more.
,+e )agina" disc+arge may +a)e an offensi)e sme"" and t+e co"our may be
c+anged from *atery to c"oudy.
S+e may +a)e an increased pu"se rate (more t+an 133 beats@minute).
,+e feta" +eart beat may increase to 1-3 beats@minute or more.
S+e may fee" pain in t+e "o*er abdomen7 particu"ar"y *+en it is touc+ed.
17.$. Malpresentation of t*e fetus
Rupture of feta" membranes is +ig+"y associated *it+ feta" ma"presentations in t+e
t+ird trimester. Particu"ar"y +ig+ ris$ of PROM is associated *it+ foot"ing breec+ (feet
first) and trans)erse "ie (across t+e abdomen) *it+ t+e baby9s bac$ arc+ed up*ards
and +ands and "egs pointing do*n7 in direct contact *it+ t+e *ea$est point of t+e
membranes.
17.$.$ Multiple pregnancy and e'cess amniotic fluid
If t+e uterus +o"ds t*o or more babies7 or t+ere is e'cess accumu"ation of amniotic
f"uid (po"y+ydramnios)7 t+e feta" membranes become o)er6stretc+ed and rupture. ,+e
membranes can rupture e)en if t+e amount of amniotic f"uid is sma""7 if t+ere is
anot+er cause suc+ as t+ose described be"o*.
>Po"y9 means e'cess7 >+ydra9 means *ater7 and >amnios9 refers to t+e amniotic f"uid.
So >po"y+ydramnios9 means >too muc+ amniotic f"uid9.
17.$.+ !er(ical incompetence
%
4it+out uterine contraction7 t+e cer)i' may di"ate spontaneous"y ear"y in gestation
and t+is can be t+e cause for an abortion (miscarriage). ,+e cer)i' may di"ate e)en in
"ate pregnancy before t+e onset of "abour. 0s t+e cer)i' continues di"ating7 it *i""
a""o* part of t+e feta" membranes to pass t+roug+ it. 0s a resu"t7 t+e membranes can
rupture easi"y and "ea$ amniotic f"uid.
17.$., "rauma to t*e abdomen
0ny b"unt or penetrating trauma to t+e abdomina" *a"" can resu"t in a brea$ in t+e
feta" membranes. &"unt traumas inc"ude; uterine manipu"ation by a doctor or mid*ife
to c+ange t+e feta" presentation from breec+ or trans)erse "ie to t+e norma" >+ead
do*n9 or )erte' presentation< uterine massage by traditiona" +ea"ers< and b"unt
abdomina" in?ury (e.g. from a b"o* or fa""). 0n e'amp"e of a penetrating abdomina"
in?ury is insertion of a +o""o* need"e into t+e amniotic ca)ity t+roug+ t+e abdomina"
*a""7 or t+roug+ t+e cer)i'7 to *it+dra* amniotic f"uid or p"acenta" tissue for ana"ysis.
17.+ -iagnosis of PROM
4+en t+ere is a rupture in t+e feta" membranes7 t+e *oman notices a pain"ess sudden
"ea$age of f"uid from +er )agina7 *+ic+ is usua""y e'cess and *atery. Bo*e)er7 *+en
t+e amount of amniotic f"uid in t+e sac is minima"7 t+e "ea$ing f"uid may on"y *et +er
under*ear7 and you may be unsure *+et+er to ma$e t+e diagnosis of PROM from t+e
*oman9s comp"aint.
,+e mot+er may be *orried7 but not be sure *+et+er t+e "ea$age is norma" or
abnorma". 0 "itt"e bit of e'cess )agina" disc+arge is norma" near to fu"" term7 and t+is
may be confused *it+ t+e "ea$age of amniotic f"uid. So you need to refer any *oman
comp"aining of e'cess )agina" disc+arge for furt+er e)a"uation at a +ig+er "e)e" +ea"t+
faci"ity7 in case t+e *oman is s+o*ing signs of PROM.
&o' 17.1 summarises t+e c"inica" features t+at can +e"p you to ma$e t+e diagnosis of
PROM.
&o' 17.1 !linical features of PROM
,+e *oman comp"ains of "ea$age of f"uid from +er )agina (minima" or
e'cess).
S+e says s+e noticed a decrease in t+e siDe of +er abdomen after "ea$age of
f"uid.
:ou obser)e *atery f"uid coming out t+roug+ t+e )agina7 or t+e *oman9s
under c"ot+ing is soa$ed *it+ *atery f"uid.
4+en you measure t+e distance bet*een t+e pubic symp+ysis and t+e funda"
+eig+t (as described in Study Session 2)7 you find t+e baby is sma"" for
gestationa" age. (Eote t+at being >sma"" for gestationa" age9 can a"so be due to
scanty amount of amniotic f"uid *it+ intact membranes7 intrauterine gro*t+
restriction and *rong date for t+e stated gestationa" age.)
-
In PROM7 t+e amniotic f"uid remaining in t+e sac *i"" be minima"7 so you may
be ab"e to fee" (pa"pate) t+e feta" parts easi"y t+roug+ t+e mot+er9s abdomen.
0"t+oug+ not specific7 t+e *oman may +a)e an offensi)e sme"" due to )agina"
disc+arge7 and s+e may +a)e a fe)er (see &o' 17.1 abo)e)< t+ese signs indicate
an a"ready estab"is+ed infection7 *+ic+ may be t+e cause of PROM.
:ou can gi)e +er a dry )agina" pad or Fot+ and c+ec$ after some +ours
*+et+er it is *et or sti"" dry. Eote t+at being dry doesn9t necessari"y ru"e out
PROM.
17., !omplications of PROM
PROM is associated *it+ se)era" potentia""y "ife6t+reatening comp"ications7 as *e *i""
no* describe.
17.,.1 Infection after PROM
0s stated ear"ier7 t+e premature rupture of feta" membranes a""o*s bacteria to get into
t+e uterine ca)ity. ,+ey mu"tip"y rapid"y in t+e *arm7 *et en)ironment and7 as a
resu"t7 bot+ t+e mot+er and t+e fetus may de)e"op a "ife6t+reatening infection. It can
continue e)en after t+e birt+ as uterine or *idespread infection in t+e mot+er7 and
cause pneumonia7 sepsis (b"ood infection) or meningitis (infection of t+e brain) in t+e
ne*born.
Infection is one of t+e most feared comp"ications of PROM because7 un"ess it is
Guic$"y treated7 it may end up *it+ bot+ materna" and feta" or ne*born deat+. &ut t+e
good ne*s is t+at s*ift treatment *it+ antibiotics is genera""y successfu".
It s+ou"d be noted t+at prolonged PROM cases are +ig+"y "i$e"y to de)e"op a uterine
infection un"ess treated Guic$"y *it+ pre)enti)e antibiotics.
.uestion
4+y do you t+in$ pro"onged PROM is particu"ar"y "i$e"y to "ead to infection5
/ns)er
O)er 1 +ours +a)e passed since t+e feta" membranes ruptured7 so any bacteria t+at
got into t+e uterus +a)e enoug+ time to mu"tip"y and ta$e +o"d.
(nd of ans*er
17.,. !ord prolapse
7
=
1igure 17.1 Pro"apsed cord is a dangerous comp"ication of PROM.
One of t+e potentia""y fata" comp"ications of PROM for t+e baby is umbilical cord
prolapse. (,+e term >pro"apse9 means >pus+ing out of t+e proper p"ace9.) 4+en t+e
membranes rupture7 t+e umbi"ica" cord may be *as+ed do*n*ards by t+e rus+ing out
of amniotic f"uid and fa"" to*ards t+e )agina. It may be pus+ed a+ead of t+e baby and
pus+ out into t+e cer)i' (see 1igure 17.1) t+roug+ t+e brea$ in t+e membranes. In t+is
position7 t+e pro"apsed cord is easi"y compressed7 cutting off t+e b"ood supp"y to t+e
fetus and t+is can be t+e cause of sudden feta" deat+.
17.,.$ 0etal *ypo'ia and asp*y'ia
4+en t+e ruptured feta" membranes +a)e "ea$ed most of t+e f"uid t+at $eeps t+e fetus
>f"oating9 in t+e uterus7 t+e membranes co""apse around t+e baby7 and t+e baby can
press against t+e uterine *a"". It can "ie on and compress t+e umbi"ica" cord7 so t+e
fetus becomes s+ort of o'ygen and t+e *aste product carbon dio'ide bui"ds up in its
body.
.eficiency of o'ygen and accumu"ation of carbon dio'ide in t+e body is ca""ed
*ypo'ia ("itera""y >"o* o'ygen9)7 *+ic+ rapid"y "eads to asp*y'ia (brain and tissue
damage due to +ypo'ia) resu"ting in deat+ if o'ygen is not Guic$"y restored.
,+e fetus can a"so de)e"op asp+y'ia and die because of partia" or comp"ete p"acenta"
abruption7 as described ne't.
17.,.+ Placental abruption
4+en t+e cause of t+e rupture of feta" membranes is an o)er6stretc+ed uterus7 t+ere is
a possibi"ity of premature separation of t+e p"acenta from t+e uterine *a"" (a condition
ca""ed placental abruption *+ic+ you *i"" "earn more about in Study Session 1). ,+is
can +appen *+en a gus+ of f"uid sudden"y f"o*s out of t+e uterus7 ripping part of t+e
p"acenta a*ay from t+e uterine *a"".
17.,., Preterm labour
Once t+e feta" membranes rupture7 "abour usua""y starts spontaneous"y in "ess t+an one
*ee$. If t+e PROM occurs se)era" *ee$s before t+e pregnancy reac+es fu"" term7 t+e
resu"ting "abour *i"" a"so be preterm7 and t+is can pose a ris$ to t+e ne*born. Its
de)e"opment may not be sufficient"y mature to sustain "ife H for e'amp"e7 t+e
preterm baby cannot maintain its body temperature as *e"" as a fu"" term baby7 its
respiration *i"" be s+a""o*7 it may +a)e troub"e feeding and its immune system may
not be ab"e to protect it from infection.
17.,.1 -eformity of fetal limbs
Sometimes "abour does not start spontaneous"y after PROM. ,+is is t+e most ris$y
situation for de)e"opment of infection and feta" deformity7 if it occurs too ear"y in
gestation and t+e pregnancy continues for a "ong period of time after t+e membranes
+a)e ruptured.
2
4it+out t+e amniotic f"uid to $eep t+e fetus >f"oating97 t+e muscu"ar *a""s of t+e
uterus c"ose"y surround t+e fetus and compress it. ,+e immature feta" bones are not
yet strong enoug+ to resist t+e pressure7 and t+e c+ance of de)e"oping deformity of t+e
"egs7 feet7 arms or +ands is )ery +ig+ if t+e pregnancy continues in t+is state for more
t+an 3 *ee$s.
17.1 /ctions in a case of PROM
4+ene)er you see a *oman *it+ c"ear"y defined or suspected PROM7 t+e Guestions
you need to ans*er are;
1. .oes t+e *oman +a)e estab"is+ed "abour or not5
. If t+e *oman +as estab"is+ed "abour;
o Is it preterm or term PROM5
o Bo* "ong +as s+e stayed at +ome after t+e membranes ruptured5
o Bo* muc+ +as t+e "abour progressed5
3. Is t+e fetus a"i)e or dead5
#. Irrespecti)e of "abour condition7 does t+e *oman +a)e estab"is+ed infection or
not5
:ou need to ans*er t+e abo)e Guestions because t+ey s+o* *+at actions you need to
ta$e7 as *e *i"" no* describe.
17.1.1 2*en s*ould you conduct t*e deli(ery before referral3
Inder certain conditions7 it is safer for you to conduct t+e de"i)ery of a *oman *it+
PROM *+ere s+e is (at +er +ome or your Bea"t+ Post) before referra".
.uestion
!an you e'p"ain *+y not5
/ns)er
It great"y increases t+e ris$ of infection getting into t+e uterus.
(nd of ans*er
:ou s+ou"d support +er t+roug+ t+e "abour before referra" if s+e is;
13
.on
9t do an interna" )agina" e'amination7 e)en *earing surgica" g"o)es7 in a *oman *it+
PROMJ
a"ready in established labour (yes to /uestion 1 abo)e)
and s+e came to you *it+ a +istory of term PROM7 after 37 comp"eted *ee$s
of gestation and t+e "ea$age of f"uid +appened before t+e onset of "abour
(/uestion )
and you see no evidence of infection (no to /uestion #).
If t+e "abour and de"i)ery *as norma" and t+e *oman and baby are doing *e""7 c+ec$
t+em for t+e ne't # +ours. ,e"" t+e fami"y to ca"" you and ta$e +er to a +ea"t+ faci"ity
immediate"y if t+ere is any sign of infection in t+e mot+er or t+e ne*born.
If t+e *oman comes to you *it+ PROM and s+e is a"ready in estab"is+ed "abour
*+ic+ +as progressed a "ong *ay ("ate acti)e first stage7 or second stage *+en t+e
*oman is *anting to pus+)7 even with evidence of infection, or a preterm labour, or
you thin the fetus may be dead7 it is sti"" preferab"e to conduct t+e de"i)ery *+ere t+e
*oman is and refer +er to a +ea"t+ faci"ity as soon as t+e baby is born.
17.1. 2*en s*ould you refer before conducting t*e deli(ery3
11
Refer t+e *oman *it+ PROM as soon as possib"e to a +ospita" *it+ a surgica" faci"ity
if s+e is not in "abour7 or s+e is sti"" in t+e ear"y stage of "abour and t+ere is time to get
+er to t+e +ea"t+ faci"ity before "abour progresses muc+. Remember t+at if t+e case is
preterm PROM7 t+e ne*born *i"" need specia" care in a +ospita".
Summary of Study Session 17
In Study Session 177 you "earned t+at;
1. Premature rupture of membranes (PROM) is a spontaneous rupture of feta"
membranes and "ea$age of f"uid from t+e )agina after = *ee$s of gestation
and at "east one +our before t+e onset of true "abour.
. PROM is c"assified as preterm PROM *+en t+e "ea$age of f"uid occurs before
37 comp"eted *ee$s of gestation7 and term PROM *+en it occurs after 37
*ee$s.
3. 4omen *it+ pro"onged PROM (1 or more +ours passed since t+e rupture of
feta" membranes) are +ig+"y "i$e"y to de)e"op infection in t+e uterus un"ess t+ey
get s*ift antibiotic treatment.
#. ,+e commonest ris$ factors for PROM inc"ude infection in t+e reproducti)e
tract7 feta" ma"presentations (breec+ or trans)erse "ie)7 mu"tip"e pregnancy7
e'cess amniotic f"uid7 cer)ica" incompetence7 and abdomina" trauma.
%. ,+e diagnosis of PROM is based on a +istory of sudden and pain"ess "ea$age
of moderate or e'cess *atery f"uid from t+e )agina. :ou may *itness t+e
*oman9s soa$ed under*ear7 fee" easi"y pa"pab"e feta" parts t+roug+ +er
abdomina" *a""7 and measure t+e uterine siDe as >sma"" for gestationa" age9
because +er abdomen +as s+run$.
-. ,+e common comp"ications of PROM are infection in t+e mot+er and@or t+e
fetus@ne*born7 cord pro"apse7 intrauterine feta" asp+y'ia@deat+7 p"acenta"
abruption7 preterm "abour7 and deformity of t+e feta" "imbs.
7. 1e)er7 fou" sme""ing )agina" disc+arge7 increased materna" pu"se rate7
increased feta" +eartbeat and "o*er abdomina" pain are signs of infection in t+e
uterine ca)ity7 *+ic+ needs to be treated Guic$"y *it+ antibiotics.
=. ,o minimiDe t+e ris$ of infection7 g"o)ed digita" pe")ic e'amination s+ou"d be
a)oided in *omen *it+ PROM.
2. .e"i)er t+e baby and t+en refer in cases of term or preterm PROM *+ere t+e
*oman is a"ready in ad)anced "abour7 e)en if t+ere is e)idence of infection or in
cases of term PROM if "abour +as begun norma""y and t+ere is no e)idence of
infection.
13. Refer as soon as possib"e a"" *omen *it+ PROM coming to you before t+e
onset of "abour7 or in ear"y "abour7 *it+ estab"is+ed materna" or neonata"
infection< refer a"" preterm babies immediate"y after de"i)ery.
1
11. Ma$e sure t+at t+e *oman *it+ PROM and +er fami"y are *e"" a*are of t+e
ris$s of *aiting at +ome< counse" t+em to ca"" you at once and ta$e transport to
t+e +ea"t+ faci"ity.
Self4/ssessment .uestions (S/.s) for Study Session
17
Eo* t+at you +a)e comp"eted t+is study session7 you can assess +o* *e"" you +a)e
ac+ie)ed its Learning Outcomes by ans*ering t+e fo""o*ing Guestions. 4rite your
ans*ers in your Study .iary and discuss t+em *it+ your ,utor at t+e ne't Study
Support Meeting. :ou can c+ec$ your ans*ers *it+ t+e Eotes on t+e Se"f60ssessment
/uestions at t+e end of t+is Modu"e.
S/. 17.1 (tests Learning Outcomes 17.1 and 17.)
!omp"ete t+e missing information in ,ab"e 17.1.
"able 17.1
PROM classification 5estational age
Preterm PROM
,erm PROM
Inter(al since membranes ruptured
(ar"y PROM
Pro"onged PROM
/ns)er
,+e comp"eted ,ab"e 17.1 s+ou"d "oo$ "i$e t+is;
"able 17.1
PROM classification 5estational age
Preterm PROM 0fter = *ee$s and before 37 *ee$s
,erm PROM 0fter 37 *ee$s7 inc"uding post6term (after #3 *ee$s)
Inter(al since membranes ruptured
(ar"y PROM Less t+an 1 +ours
Pro"onged PROM More t+an 1 +ours
(nd of ans*er
S/. 17. (tests Learning Outcomes 17.16 17.$6 17.+ and 17.,)
4+ic+ of t+e fo""o*ing statements is false5 In eac+ case7 e'p"ain *+at is incorrect.
0 Infection in t+e uterus may cause PROM and may a"so be a comp"ication fo""o*ing
PROM.
13
& PROM may occur if t+e uterus is o)er6stretc+ed by ma"presentation of t+e fetus7
mu"tip"e pregnancy or e'cess amniotic f"uid.
! !er)ica" incompetence in combination *it+ PROM can be a cause of umbi"ica"
cord pro"apse.
. ,+e feta" membranes are so strong t+at b"unt trauma to t+e abdomen is un"i$e"y to
cause PROM.
( Bypo'ia and asp+y'ia of t+e *oman in "abour is a common comp"ication of
pro"onged PROM.
1 0 sudden gus+ of c"ear *atery f"uid from t+e )agina is a"*ays seen in cases of
PROM.
/ns)er
0 is true. Infection in t+e uterus may cause PROM and may a"so be a comp"ication
fo""o*ing PROM.
& is true. Prom may occur if t+e uterus is o)er6stretc+ed by ma"presentation of t+e
fetus7 mu"tip"e pregnancy or e'cess amniotic f"uid.
! is true. !er)ica" incompetence in combination *it+ PROM can be a cause of
umbi"ica" cord pro"apse.
. is false. &"unt trauma to t+e abdomen is a common cause of PROM.
( is false. Bypo'ia and asp+y'ia of t+e fetus (not t+e *oman in "abour) is a common
comp"ication of pro"onged PROM.
1 is false. Some cases of PROM occur without a sudden gus+ of c"ear *atery f"uid
from t+e )agina7 so you s+ou"d a"*ays ta$e account of ot+er diagnostic signs suc+ as
reduction in siDe of t+e abdomen and c"ear"y pa"pab"e feta" parts.
(nd of ans*er
Read !ase Study 17.1 and t+en ans*er t+e Guestions t+at fo""o* it.
!ase Study 17.1 7ufan8s story
8ufan9s fami"y contact you to say t+at +er *aters bro$e # +ours ear"ier7 but t+ey are
concerned because +er "abour +as not started yet. ,+ey t+in$ t+e baby *as due to be
born "ast *ee$. S+e fee"s +ot to t+e touc+ and is becoming rest"ess and comp"aining of
pain in +er "o*er abdomen.
S/. 17.$ (tests Learning Outcomes 17.16 17.6 17., and 17.1)
1. Bo* do you c"assify 8ufan9s case of PROM5
1#
. .oes s+e +a)e t+e signs of any comp"ications5
3. Is t+ere anyt+ing you cou"d +a)e done to pre)ent +er condition from
*orsening5
#. 4+at immediate action s+ou"d you ta$e5
/ns)er
1. 8ufan9s condition s+ou"d be c"assified as post6term pro"onged PROM7 because
t+e gestationa" age is a"ready beyond #3 *ee$s and +er membranes ruptured
more t+an 1 +ours ago.
. S+e +as t*o c"ear signs of abdomina" infection; fe)er and "o*er abdomina"
pain.
3. :ou cou"d +a)e pre)ented +er condition from *orsening if you +ad counse""ed
8ufan and +er fami"y more c"ear"y about t+e ris$s of *aiting at +ome after t+e
membranes +a)e ruptured.
#. :ou s+ou"d immediate"y refer +er to t+e nearest +ospita" or +ea"t+ centre *it+
surgica" faci"ities< s+e *i"" a"so need antibiotics Guic$"y to treat t+e infection.
(nd of ans*er
1%