Preterm Prelabour Rupture of Membranes (PPROM)
Summary
This is a summary on PPROM.
Basics
This occurs as a rupture of membranes before 37 weeks of gestation. Like PROM, this diagnosis should be confirmed with a sterile speculum examination to demonstrate the leakage of the amniotic fluid. All cases should be referred to a higher level of care.
Investigations
- If uncertain, test for the pH of the fluid (liquor is alkaline).
Management
- Avoid digital examination
- Assess fetal well being
- Estimate fetal weight
- Prepare for the delivery of a preterm neonate to improve lung maturity (26 – 34 weeks of gestation):
- Betamethasone 12mg 12 hourly (2 doses) IM. Take note that there are several ways of prescribing this. Some prefer 12mg 24 hourly (2 doses). If Betamethasone is not available, then you may use Dexamethasone 8mg IM 8 hourly (for 3 doses).
- Benefits of antenatal corticosteroids reduces mortality, respiratory distress syndrome, intraventricular haemorrhage, and necrotizing enterocolitis.
- Corticosteroids are maximally effective from 24 hours of administration.
- Antibiotics:
- Amoxicillin 500mg 8 hourly until referral (this is continued for 5 days) and Metronidazole 400mg PO 8 hourly until referral (this is continued for 5 days). If there is a penicillin allergy, replace amoxicillin for azithromycin 500mg PO daily.
References and Further Reading
1. The National Department of Health, South Africa: Essential Drugs
Programme. Primary Healthcare Standard Treatment Guideline and
Essential Medicine List. 7th ed. South African National Department of Health;
2020.
2. Antenatal corticosteroid therapy for fetal maturation (no date) ACOG. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation (Accessed: November 7, 2022). .
2. Antenatal corticosteroid therapy for fetal maturation (no date) ACOG. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/antenatal-corticosteroid-therapy-for-fetal-maturation (Accessed: November 7, 2022). .
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