8% of pregnancies at term. Women will deliver
Risk: Longer duration of rupture risk for
Postpartum endometritis (3%) - (10-30% after C/S) Neonatal infection (1-3%) 70% will deliver in less than 24 hours 85% will deliver in less than 48 hours Some obstetricians go for prompt induction with oxytocin because of small reduction in maternal and neonatal infection rate. Other prefere short term expectation < 24 hours. Management: Either acute induction (prostaglandin in case of unripe cervix). Conservative Management: (short term expectant: < 24 hours. In some studies decreased Cesarean section rate Temperature measured twice daily. Antibiotic or if not in after 18-24 hours. If GBS positive, see GBS syndrome. Gestational weeks 34 + 0 - 35 + 6 can be treated as PPROM. Induction of : Comparing the use of oxytocin to PGE2 (vaginal or intracervical) in women with ruptured membranes, the use of prostaglandins resulted in some studies higher success and satisfaction rate. Oxytocin is preferable in case of a ripe cervix as neonatal infection rate and endometritis seems to be decreased compared to Prostaglandins. References: (1) Dare MR et al. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes aat term (37 weeks or more). Cochrane Database Syst Rev. 2006 Jan;(1):CD005302. (2) ACOG Practice Bulletin No. 80. Premature rupture of membranes: Obstet. Gyncol. 2007;109(4):1007-19 (3) Royal College of Obstetriciand and Gynecologist Guideline No. 44, Nov. 2006 (4) www.uptodate.com 2007
Feel free to mail me the webmaster Dr Lars Krag Moeller if you have corrections that could improve the manual. |