Premature Rupture of membranes (PPROM)

Debate is: How long one can wait in PPROM-say gestational age  < 32 weeks ? How much time we can wait for spontaneous labour in a term patient with leaking with antibiotics support??

·         Option 1: Wait 12 hours, meanwhile IV MgSo4 & antibitics.USG .  To assess BISHOPS and proceed accordingly. In UK, I was told, that induction after 24 hrs of leaking is the routine practice because infection will set in sooner or later and there can be retraction of uterus due to contd leak  and abruptio of pl can follow but there are few practioner don’t like to wait >  8 hrs if pains don’t ensue

·         Therefore there is debate when to initiate action? My own suggestion is 12 hours should be the cutoff point but if Bishop’s scores are favorable then  may initiate  Syntocinon  drip straightway  .

·         Why waiting for 12 hrs?? Ans:, many of us  believe that beyond 12 hours post leaking infn rate will be high. In  our circumstances at India 12 hours is acceptable & sufficient . Sometimes pts don't communicate  proper history and may come to hospital leaking  beyond  24  hrs, May be she has already intrapartum sepsis set in

·          It also depends on whether it is frank leaking or mild leaking.

·          During this time (expectant period)  as many as  70% of women go into spontaneous labour. Remaining 30% need active intervention. In such 30 % cases

·         Options:--1) May Induce with 25 mcg misoprostol. ,
2) if unfavourable, but one considers that still normal delivery is possible, one may try with  misoprostol . But there is no point in much delaying beyond 12 hrs. . .. Mostly with good Bishops will proceed to active labour. 18 hrs. beyond that it becomes prolonged labour. High chances of choriomnionitis

·         Option 2: Act on admission: Primigravida -do per speculum exam with asepsis, There is another school who put cerviprime or misoprostol 25 mcgposterior fornix-on admission along with parental inj antibiotics and next review time frame will be after 24hrs if pt not in labor already-CS may be done depending on cx condition. In  our circumstances at India 12 hours is accepatable & sufficient . Sometimes pts don't communicate  proper history and may come to hospital leaking  beyond  24  hrs, May be she has already intrapartum sepsis set in It also depends on whether it is frank leaking or mild leaking