Management of preterm premature rupture of membrane in a high-risk pregnancy
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20240154Keywords:
Preterm premature rupture of membranes, Cervical insufficiency, ChorioamnionitisAbstract
Preterm premature rupture of membranes (PPROM) usually has a multi factorial aetiology that is often unknown, although the most frequently reported cause is infection, others could be cervical insufficiency, over distention of uterine cavity, previous history of preterm labor, systemic inflammatory disease etc. This case report documented a rare incidence of preterm premature rupture of membranes, in a 35-year-old female with past history of 8 spontaneous abortions and 1 ectopic pregnancy. Patient had an IVF conception, amenorrheic for 7 months and 2 weeks, and came with a complaint of white discharge per vaginum. On per speculum examination, cervical os was found dilated. The patient was managed conservatively with protein and progesterone support along with prophylactic tocolytics and antibiotics, till early signs of chorioamnionitis were noticed. The decision of induction of labour and eventually preterm premature rupture of membranes lead to emergency cesarean section. Challenges faced in managing this high risk pregnancy are discussed, emphasizing the need of close monitoring and tailoring management in similar circumstances.
References
Merenstein GB, Weisman LE. Premature rupture of the membranes: neonatal consequences. Semin Perinatol. 1996;20(5):375-80.
RCOG. Preterm prelabour rupture of membranes, 2022. Available at: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/preterm-prelabour-rupture-of-membranes-green-top-guideline-no-44/. Accessed on 10 December 2023.
Romero R, Quintero R, Oyarzun E, Wu YK, Sabo V. Intraamniotic infection and the onset of labor in preterm premature rupture of the membranes. Am J Obstet Gynecol. 1988;159:661-6.
Musilova I, Kacerovsky M, Stepan M, Bestvina T, Pliskova L, Zednikova B, et al. Maternal serum C-reactive protein concentration and intra-amniotic inflammation in women with preterm prelabor rupture of membranes. PLoS One. 2017;12(8):0182731.
Bond DM, Middleton P, Levett KM, Ham DPV, Crowther CA, Buchanan SL, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2017;3(3):004735.