ACOG Management of PROM and pPROM
In cases of premature rupture of membranes, ACOG recommends identifying gestational age, fetal presentation and well being. When the pregnancy is at or near term (34 weeks or later), induction of labor is recommended with the administration of a Group B streptococcal prophylaxis, if necessary.
In cases of pPROM occurring at 32 weeks or earlier, the decision to induce labor is dependent on pulmonary maturity and on the capability of the facility to provide adequate management of preterm labor. ACOG recommends expectant management of pPROM cases in which inducing labor is not an option. Complications of pPROM can be reduced by modified bed rest to promote the accumulation of amniotic fluid, as well as by ongoing monitoring for umbilical compression, infection and placental abruption.1
Diagnosing PROM and pPROM
Accurate diagnosis of PROM is a persistent challenge, particularly for clinics with limited resources. In many cases, a visual examination is sufficient to identify the presence of amniotic fluid pooling at the posterior cervical os. Fern testing or nitrazine testing can also be used to confirm this diagnosis, though both processes are susceptible to false positives and false negatives. Visual inspection is also an inadequate tool in the estimated 47% of PROM cases which present no observable symptoms. 1
One of the newest developments in the diagnosis of PROM and pPROM is the identification of the placental alpha microglobulin (PAMG-1) protein as a viable biomarker. AmniSure (PAMG-1) can be used as an aid in diagnosing rupture of membranes with up to ~99% accuracy, without requiring an invasive speculum exam or any expensive equipment. It can aid practitioners in the proper interventions earlier and more effectively.
- Neil PRL, Wallace EM. Is AmniSure® useful in the management of women with prelabour rupture of the membranes? Australian and New Zealand Journal of Obstetrics and Gynaecology 2010.