Preterm Premature Rupture of Membranes (PPROM)

Preterm Premature Rupture of Membranes (PPROM)

Definition

Preterm premature rupture of membranes (PPROM) is defined as premature rupture of membranes before 37 completed weeks.

Risk Factors for PROM

• Increasing friability/decreased tensile strength of membranes mainly due to infections like bacterial vaginosisZ.
• Polyhydramnios
• Multiple pregnancy
• Cervical incompetence
• Previous H/O PROM

Diagnosis

• Frank leakage
• Ultrasound
• Nitrazine test
• Ferin test
• Fibronectin

Management Based on Gestational AgeY

34 weeks or more

• Plan delivery: labor induction unless contraindicated
• Group B streptococcal prophylaxis[^1]
• Single corticosteroid course may be considered up to $36^{6/7}$ weeks[^2]

32 weeks to 33 completed weeks

• Expectant management
• Group B streptococcal prophylaxis[^1]
• Single corticosteroid course[^3]
• Antimicrobials to prolong latency

24 weeks to 31 completed weeksY

• Expectant management
• Group B streptococcal prophylaxis[^1]
• Single corticosteroid course[^3]
• Tocolytics: no consensus
• Antimicrobials to prolong latency
• Magnesium sulfate for neuroprotection may be considered[^4]

<24 weeks

• Expectant management or induction of labor[^5]
• Group B streptococcal prophylaxis is not recommended[^6]
• Single corticosteroid course may be considered[^5][^6]
• Tocolytics: no consensus[^5][^6]
• Antimicrobials: may be considered[^5][^7]

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Antenatal Corticosteroids (ACS)

Drugs

• steroids
  • Betamethasone (12 mg Q24h × 2 doses)
  • Dexamethasone (6 mg Q12h × 4 doses)

Mechanism

• Accelerates development of type 1 and type 2 pneumocytes
• Stimulates the synthesis and release of surfactant
• Induces airway epithelial sodium channel gene expression

Benefits for Newborn

• Decrease incidence of respiratory distress
• Decrease need for respiratory support
• May decrease duration of NICU/special care nursery stay

Side effects in newborn shorterm: Hypoglycemia in late-preterm infants Longterm: May increase risk for mental behavioral and neurocognitive disorder

Antibiotic Regimens

Initial Parenteral Phase:

• Ampicillin 2 g IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours

Oral Phase:

• Followed by amoxicillin 250 mg orally every 8 hours and erythromycin 333 mg orally every 8 hours for 5 days (I-A)

Oral Antibiotic:

• Erythromycin 250 mg orally every 6 hours for 10 days (I-A)

Why We Give Antibiotics

• Protects against infection-related complications.
• Prolongs the pregnancy course.
• Reduces preterm-related morbidity and mortality.