©Pregnancy bliss 2008

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Pregnancy and Childbirth: The answers

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The conservative approach is not favored by everybody, however. Some obstetricians start the process of induction of labor as soon as the mother is admitted with ruptured mem­branes at this gestation. Still others try to compromise by putting a limit to the waiting time. After this time has elapsed (without labor), induction of labor is commenced. It is clear that there are many ways to proceed and none of the policies can claim to be significantly superior to the next.

 

Improving outcome in pre-labor pre-term rupture of membranes  (PPROM)

The main measure is keeping a close surveillance to detect the development of infection at the earliest possible stage. These measures will include monitoring the mother's own vital signs, including temperature and serial blood tests. Some will add vaginal swabs every few days, but this is controversial.

 

The other measure is monitoring the fetal well-being.

 

Outpatient management of pre-term rupture of membranes

It is being increasingly accepted that women with preterm rupture of membranes can be managed on an outpatient basis and that admission until delivery is not an absolute necessity for everyone.

 

Of-course each individual is carefully assessed for suitability to this approach.

 

The role of antibiotics in pre-term membrane rupture

It is now accepted that antibiotics in preterm rupture of membranes are beneficial and every woman finding herself in this situation is prescribed a course of these, usually Erythromycin. A substitute is used in the rare case of allergy to this antibiotic.

A therapeutic course of appropriate antibiotics is also necessary in cases where there is already evidence of infection, where treatment is commenced, together with putting delivery plans under way. In such a situation, there is no time to waste.

 

The role of Progesterone in pre-term membrane rupture

There is evidence that, for some women at least, the administration of Progesterone (progestin) hormone after preterm membrane rupture could prolong the pregnancy and gain a crucial number of days, even weeks, for the baby to stay in the womb. This may help avoid severe prematurity with all the consequences that come with that.

 

17-alpha progesterone caproate, also known by the short form ‘17P’ is used for this. This is a natural progestin and is safe in pregnancy. High quality studies published in 2003 showed that the use 17P would reduce the risk of preterm labor and delivery by about a third. It is administered in the form of weekly injections or daily vaginal (or rectal) suppositories. A study published in 2007 showed that the hormone does not confer a similar benefit in twin pregnancy.

 

There is no evidence that 17P can help prevent pre-term pre-labor rupture of membranes (PPROM)

 

 

 

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Progesterone injections may help delay delivery in PPROM
Progesterone suppositories may help delay delivery in PPROM

Progesterone to reduce thre risk of preterm delivery is administered in the form of injections (above) or suppositories (below)