HSV infection and Preterm PROM
Vertical transmission
Expectant management
HSV therapy
Cesarean delivery
Recurrent active HSV
Primary HSV
3%
30-50%
Recommended
Controversial
Recommended
Recommended
Recommended if active disease or prodromal symptoms are
present at time of delivery
Cervical Cerclage in women with PPROM:
 The optimal timing for cerclage removal is unclear.
< 23 weeks gestation: remove cerclage (to ↓ infection risk).
23-34 weeks gestation delayed removal, if there are no may be appropriate to
allow for completion of antenatal steroids.
 Send the cervical suture for culture, once removed
HIV infection and Preterm PROM
 Optimal obstetric management is unclear
 Standard HIV guidelines should be followed by Multidisciplinary team.
 The duration of ROM is not correlated with vertical transmission risk in patients
who are on highly active antiretroviral therapy as they have a low viral load.
 The management should be individualized depending on gestational age, viral
load, and duration since the patient is on antiretroviral therapy.
Cervical Cerclage in women with PPROM:

The optimal timing for cerclage removal is unclear.
< 23 weeks gestation: remove cerclage (to ↓ infection risk).
23-34 weeks gestation delayed removal, if there are no may be appropriate to
allow for completion of antenatal steroids.

Send the cervical suture for culture, once removed.
PROM at term:



Incidence of PROM at term is 8%.
Prognosis: 60% will be in labour spontaneously within 24hours and over
91% within 48 hours. 6% remain pregnant beyond 96hours.
Routine obstetric evaluation of cases of term PROM with consideration of:
1. Cervical suture at term PROM: The suture should be removed as soon as
possible and prompt birth must be considered.
2. Non-cephalic presentations with confirmed ROM at term: digital vaginal
examination to exclude cord presentation.


Women with PROM at term should be informed of the risks and benefits of
the options of active and expectant management. Active management is
preferred if spontaneous labor is not started within 24 h.
Induction of labour (IOL) with vaginal prostaglandins is associated with an
increased risk of chorioamnionitis and neonatal infection in comparison
with an oxytocin induction (1st choice).

Antibiotics:
- - - Latency antibiotics are not recommended.
- GBS prophylaxis in GBS +ve cases or unknown GBS status.

Criteria for expectant management
1.
2.
3.
4.
5.
6.
GBS negative / unknown
Cephalic presentation
Clear liquor
No signs of infection (maternal tachycardia, fever, uterine tenderness)
No cervical suture
Woman able to assess: (Temperature 4 hourly+ vaginal loss+ fetal
mpovements)
7. Reactive CTGCTG only required if additional risk factors present