Episode 1: PPROM

The Uterine Sound Podcast

Join hosts Anne, Mel, and Carla on an exciting episode of The Uterine Sound podcast as they delve into the mysterious world of PPROM (Preterm Pre-labour rupture of membranes). Uncover the incidence, risk factors, diagnosis, and management of this condition that affects 3% of pregnancies and is associated with 30-40% of preterm births. From exploring the complex interplay between extracellular membrane proteins and matrix metalloproteases to discussing the important diagnostic tests and their accuracy, this episode will keep you on the edge of your seat. We'll also discuss the important trials, experimental therapies and special situations like women with cerclage, meconium liquor, HSV/HIV.

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Reference List:

Up-to-date: PPROM: Management and Outcome

Up-to-date: PPROM: Clinical manifestations and diagnosis

Up-to-date: Prelabour rupture of membranes before and at the limit of viability

RCOG Green Top Guideline 73: Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation “Thomson AJ, on behalf of the Royal College of Obstetricians and Gynaecologists. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation. BJOG 2019;126:e152–166”

RCOG Green Top Guideline 36: Prevention of Early Onset Group B Streptococcal Disease

ACOG Practice Bulletin 217: Prelabour Rupture of Membranes Jan 2018

SOGC No 233: Antibiotic therapy in PPROM

Ramsauer B, Vidaeff AC, Hösli I, Park JS, Strauss A, Khodjaeva Z, de la Cruz ÁA, Martínez-Astorquiza T, Horovitz J, Coatleven F, Helmer H. The diagnosis of rupture of fetal membranes (ROM): a meta-analysis. J Perinat Med. 2013 May;41(3):233-40. doi: 10.1515/jpm-2012-0247. PMID: 23314505.

Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet. 2001 Mar 31;357(9261):979-88. doi: 10.1016/s0140-6736(00)04233-1. Erratum in: Lancet 2001 Jul 14;358(9276):156. PMID: 11293640.

Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. ORACLE Collaborative Group. Lancet. 2001 Mar 31;357(9261):989-94. doi: 10.1016/s0140-6736(00)04234-3. PMID: 11293641.

Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, Thornton JG, Crowther CA; PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016 Jan 30;387(10017):444-52. doi: 10.1016/S0140-6736(15)00724-2. Epub 2015 Nov 10. PMID: 26564381.

van der Ham DP, Vijgen SM, Nijhuis JG, van Beek JJ, Opmeer BC, Mulder AL, Moonen R, Groenewout M, van Pampus MG, Mantel GD, Bloemenkamp KW, van Wijngaarden WJ, Sikkema M, Haak MC, Pernet PJ, Porath M, Molkenboer JF, Kuppens S, Kwee A, Kars ME, Woiski M, Weinans MJ, Wildschut HI, Akerboom BM, Mol BW, Willekes C; PPROMEXIL trial group. Induction of labor versus expectant management in women with preterm prelabor rupture of membranes between 34 and 37 weeks: a randomized controlled trial. PLoS Med. 2012;9(4):e1001208. doi: 10.1371/journal.pmed.1001208. Epub 2012 Apr 24. PMID: 22545024; PMCID: PMC3335867.

Tajik P, van der Ham DP, Zafarmand MH, Hof MH, Morris J, Franssen MT, de Groot CJ, Duvekot JJ, Oudijk MA, Willekes C, Bloemenkamp KW, Porath M, Woiski M, Akerboom BM, Sikkema JM, Nij Bijvank B, Mulder AL, Bossuyt PM, Mol BW. Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials. BJOG. 2014 Sep;121(10):1263-72; discussion 1273. doi: 10.1111/1471-0528.12889. Epub 2014 May 27. PMID: 24862166.

Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA, Buchanan SL, Morris J. 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 Mar 3;3(3):CD004735. doi: 10.1002/14651858.CD004735.pub4. PMID: 28257562; PMCID: PMC6464692.

Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, Ramsey RD, Rabello YA, Meis PJ, Moawad AH, Iams JD, Van Dorsten JP, Paul RH, Bottoms SF, Merenstein G, Thom EA, Roberts JM, McNellis D. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA. 1997 Sep 24;278(12):989-95. PMID: 9307346.