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KMID : 0377619970620040347
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Korean Jungang Medical Journal
1997 Volume.62 No. 4 p.347 ~ p.351
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Management of PROM, Kyushu University Version
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Hitoo Nakano
Satoh Shoji
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Abstract
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A modem care for low-birth weight infant is coming to meet several problems related to the management of preterm labor in the mid-trimester. In particular, preterm-PROM is a good example which contains some controversies how to manage in practice. Herein involved are prevention of the chorioamnionitis(CAM), maintenance of the amniotic fluid volume and prolongation of the pregnancy. With this in mind, I will describe how to manage patients with PROM with a special attention at preterm PROM, by reviewing experiences in Kyushu University Hospital.
Protocol for the management of preterm-PROM
For managing preterm-PROM, we adopted a strategy of management depending both on fetal lung maturity and the existence of CAM. Based on these, the protocol for such management was made to provide for individual cases with different gestational ages(Fig. 1). The main frame is as follows ;
1) If CAM is suspected by physical and laboratory examinations of the mothers(Table 1), or if the fetus is in jeopardy, the interruption of the pregnancy is inevitable.
2) When CAM or fetal jeopardy found negative, further management is to depend on gestational age of each case.
a. In cases form 21 to 29 weeks of gestation, a tocolytic agent is administered i.v. to the mother with evident uterine contraction using an infusion pump with a bed rest A daily vaginal douche and prescription of prophylactic antibiotics are also carried out. After confirming to be negative for microbial culture and the signs of CAM, the cervical indwelling catheter(PROM-fence) is settled.
b. In cases with 30-33 weeks of gestation, the induction of labor is elected after reserving a probable period for accelerating fetal lung maturity under tocolytic therapy.
c. After 34 weeks of gestation, no tocolysis is indicated and a spontaneous labor is expectantly waited. In case where a spontaneous onset of labor does not take place within 48 hours, an induction of labor is performed.
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