Step II PPROM management

[chngsr]

Hi guys
I haven't been able to find a clear management algorithm for preterm premature rupture of membranes in my review books....does anyone know what the management steps are for PPROM at different weeks....some books say wait until 36 weeks then induce, others say check FLM...i'm just very confused about the management of this situation. Thanks!

 

[Jonathan13180]

Hi guys
I haven't been able to find a clear management algorithm for preterm premature rupture of membranes in my review books....does anyone know what the management steps are for PPROM at different weeks....some books say wait until 36 weeks then induce, others say check FLM...i'm just very confused about the management of this situation. Thanks!

From S2S...check GBs, if +, treat it, and if not..bed rest w frequent f/u. Im assuming fetal monitors are utilized and if there is any sign of deterioration, then plan delivery

 

[medInUSA]

according to "master the boards step 3 page 408"

if uterine ctxns are present, do not give tocolysis

IF chorioamnionitis is present get cervical cultures, start IV antibiotics, and schedule delivery

If infection is absent and
-before viability <24 wks manage patient with bed rest at home
- preterm viability 24-33 weeks: hospitalize. give IM betamethasone if < 32 weeks. Obtain cervical cultures. Begin prophylactic ampicillin and erythromycin for 7 days
- at term >34 weeks initiate delivery

 

[medInUSA]

according to "master the boards step 3 page 408"

if uterine ctxns are present, do not give tocolysis

IF chorioamnionitis is present get cervical cultures, start IV antibiotics, and schedule delivery

If infection is absent and
-before viability <24 wks manage patient with bed rest at home
- preterm viability 24-33 weeks: hospitalize. give IM betamethasone if < 32 weeks. Obtain cervical cultures. Begin prophylactic ampicillin and erythromycin for 7 days
- at term >34 weeks initiate delivery

kaplan ob gyn notes says the same thing on page 75

additionally the OB triad of ruptured membranes:
positive fornix pooling
fluid is nitrazine positive
glass slide drying: fern +