🔑 Key Learning

  • PPROM is rupture of membranes before 37 weeks gestation and prior to onset of labour.
  • Associated with serious risks including infection, preterm birth, and neonatal morbidity.
  • Management includes erythromycin, corticosteroids, and close monitoring for signs of infection.
  • Delivery is indicated in cases of infection, foetal distress, or once near term (typically after 34 weeks).

👀 Clinical Features

  • Sudden gush or continuous leakage of clear fluid from the vagina
    • May describe increased vaginal discharge or dampness
  • Symptoms or signs of infection may include:
    • Fever
    • Uterine tenderness
    • Foul-smelling discharge

💊 Management

Antibiotics

  • Erythromycin 250 mg QDS for 10 days or until labour (whichever is sooner)
  • Avoid co-amoxiclav due to risk of necrotising enterocolitis in neonate

Corticosteroids

  • Indicated if gestational age is 24+0 to 33+6 weeks
  • Either:
    • Betamethasone 12 mg IM, two doses 24 hours apart
    • OR Dexamethasone 6 mg IM, four doses 12 hours apart

Expectant Management

  • For most women between 24+0 and 33+6 weeks gestation
  • Monitor for signs of chorioamnionitis and foetal distress
  • Regular CTG, maternal observations, blood tests, and infection screening

Delivery

  • Consider delivery at 34+0 to 36+6 weeks depending on risks and condition
  • Immediate delivery if:
    • Evidence of chorioamnionitis
    • Foetal compromise
    • Labour starts spontaneously

💥 Complications

  • Chorioamnionitis
  • Neonatal sepsis
  • Cord prolapse
  • Preterm labour and delivery
  • Pulmonary hypoplasia (especially with very early PPROM)

📝 Exam Clues & Clinchers

  • Clear vaginal fluid loss before 37 weeks → suspect PPROM
    • Erythromycin 250mg QDS
  • No uterine contractions, but leaking fluid + high temp + uterine tenderness → chorioamnionitis

🔗 Useful Links and References