PREMATURE RUPTURE OFTHE MEMBRANE

Retnayu Pradanie, S.Kep., Ns18/03/09

AMNIONThe amnion at term is a tough andtenacious but pliable membrane.It is the innermost fetal membrane andis contiguous with amnionic fluid.This particular avascular structureoccupies a role of incredibleimportance in human pregnancy.

Definition of PROM…Spontaneous rupture of the fetal membranesthat occurs before 37 completed weeks andbefore the onset of labor.

Primipara cervix dilatation < 3 cmMultipara cervix dilatation < 5 cm

Predisposing factors:Uterus hypermotility that can be caused bypyelonefritis, systisis, cervisitis, vaginitisetc.Abnormality of the membrane (very thin)Infections (amnionitis, chorioamnionitis)Multipara, malposisi, disproporsi, cervixincompetenArtificial PROM (Too early amniotomy)

Diagnosis of ruptured membranesa sterile speculum examination to visualizegross vaginal pooling of amnionic fluid,from the cervical canalInspections for meconium, verniks caseosa,lanugo, or bed smells of the amnion ifinfections occursNitrazine test: the colour’s change into blueUltrasonographic examination

PROM EffectsTo FetusInfection of the fetus caused by intrauterininfections Fetal Distress, asfixia, prematurebirth, IUFD

To MotherIntranatal until puerperium Infections, Drylabour, Fatigue, atonia uteri, HPP

Management of PROMNot viable (≤ 36 weeks):

Bed rest, Broad-spectrum parenteral antimicrobials,spasmolitics and roborantiaFetal heart rate and uterine activity are monitored forcord compression, fetal compromise, and early labor.For pregnancies less than 32 weeks, betamethasone(two 12-mg doses intramuscularly 24 hours apart) ordexamethasone (5 mg intramuscularly every 12 hoursfor four doses) is given.If the fetal status is reassuring, and if labor does notensue, the woman is usually transferred to anantepartum unit and observed for labor, infection, orfetal jeopardy.

Management of PROMViable (> 36 weeks)

Inductions of labour 6-12 hours after lagphasea parenteral antimicrobial is given forprevention of infection.if labor does not begin spontaneously afterinduction Cesarean delivery is performed forindications failed induction of labor.

Thank you…..