Management of prelabour rupture of membranes (PROM) at term

Abstract

Over a 20-month period we identified several cases of neonatal pneumonia associated with prelabour rupture of membranes (PROM) at term. PROM complicates 8%-10% of all pregnancies, yet 60% of cases occur at term. Ascending infection is a contributing factor and the incidence of chorioamnionitis in these patients is relatively high, especially with prolonged membrane rupture. The signs and symptoms NICE recommends patients look out for are not always present as the majority of infections are subclinical, yet associated maternal and neonatal morbidity of chorioamnionitis is potentially devastating. A survey of maternity units in the West Midlands reveals significant variance in management of these cases. Given the lack of consensus and clear evidence on optimal management of PROM at term, we believe early detection of developing infections could be enhanced by using a combination of investigations (at presentation, 12 and 24 h), as well as current advice to self-monitor temperature and vaginal loss.

A new antibiotic regimen treats and prevents intra-amniotic inflammation/infection in patients with preterm PROM

“…Antibiotic administration has become the standard of care for patients with preterm PROM [1,35,36,78–88]. Antimicrobial agents are prescribed to eradicate existing subclinical intra-amniotic infection, or to prevent secondary ascending infection into the amniotic cavity [1,35,36,78–89].…”

“…Antimicrobial agents are prescribed to eradicate existing subclinical intra-amniotic infection, or to prevent secondary ascending infection into the amniotic cavity [1,35,36,78–89]. Randomized clinical trials [90–104] and systematic reviews [2,105–108] indicate that antibiotic administration has short-term benefits for both pregnant women and their neonates, including prolonged pregnancy [2,91–97,99–102,105,109], reduction of neonatal respiratory distress syndrome [2,92,100,102], infection-related morbidity [2,90–92,94,98–100,102,105,106,109], and necrotizing enterocolitis [2,100,102].…”

Simplified management protocol for term neonates after prolonged rupture of membranes in a setting with high rates of neonatal sepsis and mortality: a quality improvement study

“…Rupture of membranes is also classified as preterm (<37 weeks’ gestation) or term. PROM complicates approximately 8%–10% of all pregnancies, and 60% of PROM occurs at term 10. In a multicentre study in high-income countries, the rates of neonatal infection after PROM was 2.6%,9 but in low-income countries rates as high as 17% are reported 11.…”

A transcervical amniotic fluid collector: a new medical device for the assessment of amniotic fluid in patients with ruptured membranes

“…Prelabor rupture of membranes (PROM) is defined as chorioamniorrhexis prior to the onset of labor and complicates 10% of all pregnancies [1,10,11,14,19,22,25,32,33,38,51,52,70,72,73,82,84,95,99]; in 2% of the cases, it occurs in preterm gestations [4,9,17,29,31,37,54,59,63,64,74–77,89,100–102]. Preterm PROM accounts for 30–35% of all preterm births [4,29,94].…”