PROM and PPROM

Premature rupture of membrane
Definition = ROM before onset of labor
Management

• Confirm ROM w/ speculum exam 
• Avoid too many vaginal exams (prevent infection)
• Evaluate for chorioamnionitis (fever, leukocytosis, maternal/fetal tachycardia, uterine tenderness, malodorous vaginal discharge)
• If there is chorioamnionitis, deliver despite GA + antibiotics

Preterm PROM

• Admit the patient
• Administer steroids to prevent RDS (if <32 weeks)
• US to assess GA, anomalies, AFI (is there enough fluid)

The time from premature rupture of membranes to labor is inversely related to gestational age. At term, 90% will spontaneously go into labor within 24 hours of PROM. At 28 weeks to 34 weeks, 50% will go into labor within 24 hours and 80% within 48 hours.