premature rupture of membranes
ABBR: PROM
The rupture of membranes before onset of labor. When PROM occurs at term, labor either begins spontaneously or is induced after 24 hr. Risk factors for PROM include bacterial infection, smoking, and defects of the cervix. Other factors include uterine distention due to multiple pregnancies, previous premature rupture of membranes, vaginal bleeding, sexually transmitted diseases, or low socioeconomic status of the mother. The major maternal hazard of PROM is infection, including chorioamnionitis, endometritis, and sepsis. Fetal hazards include infections, compression or prolapse of the umbilical cord, respiratory distress syndrome, or placental abruption.
SEE: prematurity.
SEE: table - Tests for Premature Rupture of Membranes.
Patient Care: PROM is diagnosed when amniotic fluid is found in the vaginal fornix. A sterile speculum is used to observe and collect amniotic fluid. The fluid can be tested with nitrazine paper (which will turn blue, demonstrating alkalinity), or it can be placed on a slide and observed for ferning. False positives can occur with both tests. Alpha-fetoprotein (AFP) and fetal fibronectin (fFN) tests have been used with varying results. An intra-amniotic dye injection is accurate but invasive. Ultrasonography can confirm gestational age, presentation, and amniotic fluid index. Digital exams should not be performed. The Amnisure test, which identifies a specific placental protein in the amniotic fluid, can be performed at the bedside and has high sensitivity and specificity. Delivery is indicated if there are signs of maternal infection or of compromise of the fetus. Antibiotics are ordered as needed, and corticosteroids are given to increase fetal lung maturity between 24 and 34 weeks. Tocolytics are given if the mother needs to be transported to a tertiary facility.
ABBR: PPROM
Rupture of the fetal membranes before completion of week 37 of pregnancy. It is the most serious form of premature rupture of membranes.SEE: prematurity.