Premature Rupture of Membranes

BY
SUPARJO
09310217

University of Malahayati
Bandar Lampung
2013/2014

1. Definition
Premature rupture of membranes (PROM) is an event that occurs during
pregnancy when the sac containing the developing baby (fetus) and the
amniotic fluid bursts or develops a hole prior to the start of labor.

2. Cause

Low socioeconomic conditions (as women in lower socioeconomic conditions are less
likely to receive proper prenatal care)

Sexually transmitted infections, such as chlamydia and gonorrhea

Previous preterm birth

Vaginal bleeding

Cigarette smoking during pregnancy

Unknown causes

3. Symtoms and signs

Gushing of fluid from vagina

Fluid leakage increases with movement change
See evaluation below

4. Risk Faktor
a. History of PROM in prior pregnancy
b. Prior Cervical Cone Biopsy
c. Amniocentesis or Cerclage
d. Uterine distention
1. Polyhydramnios
2. Multiple Gestation pregnancy
e. Tobacco abuse
f. Cervical or vaginal infections
1. Group B Streptococcus
2. Bacterial Vaginosis
3. Mycoplasma
4. Ureaplasma

5. NeisseriaGonorrhea
6. Chlamydia
g. Intercourse (unproven)

5. The pathophysiology of premature rupture of the

membranes.
Premature rupture of the membranes (PROM) is the condition in which the
chorioamnion is disrupted before the onset of labor. This condition creates a dilemma for the
practicing obstetrician, because once the membranes have broken the risk of fetal or maternal
infection, or both, increases. Preterm PROM adds to this management challenge, mainly
because of the added problem of prematurity. Although the epidemiology of PROM has been
well defined, the exact etiology has yet to be understood. However, using the associated
clinical risk factors of PROM, researchers in this field have contributed to our understanding
of the causes. Various mechanisms have been proposed, including mechanical, as well as
infectious or inflammatory processes. The purpose of this article is to review the various
proposed mechanisms of PROM. Maternal risk factors for PROM are presented, mainly to
place into context the current literature involving both in-vitro and in-vivo research. It is
apparent that a single pathophysiologic mechanism is not responsible for all cases of PROM,
but rather a combination of processes is in operation.

6. Complication
a. Premature Birth (PPROM)
b. Chorioamnionitis
c. Cord compression
d. Respiratory distress syndrome
e. Abruptio Placentae
f.

Malpresentation

7. Management
1)

Indications
a. Fetus 36 weeks gestation or
b. Weight >2500 grams or

c. Fetal Lung Maturity adequate by Amniocentesis

2) Protocol
a. Expectant management
b. Consider Oxytocin induction of labor
i. Spontaneous labor onset within 48 hours in 90%
ii. Oxytocin decreases PROM infection rates
iii. Oxytocin does not increase ceserean rates in PROM
c. Consider Cervical Ripening if unfavorable Cervix
i. Decreases risk of Chorioamnionitis in PROM
ii. Does not increase ceserean rate in PROM
d. Indications for GBS Prophylaxis
i. Prolonged ruptured membranes anticipated >18 hours
ii. Fever >38 degrees Celsius