Actim PROM

Obstetric Clinical Guidelines Group March 2009
ROYAL HOSPITAL FOR WOMEN Approved by
Patient Care Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES 2/4/09
ACTIM PROM : QUALITATIVE DIAGNOSIS OF PRETERM PREMATURE
RUPTURE OF MEMBRANES GUIDELINE
1. OPTIMAL OUTCOMES
• Diagnosis of woman with preterm premature rupture of membranes (PPROM)

Obstetric Clinical Guidelines Group March 2009 2.
ROYAL HOSPITAL FOR WOMEN Approved by
Patient Care Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES 2/4/09
ACTIM PROM : QUALITATIVE DIAGNOSIS OF PRETERM PREMATURE
RUPTURE OF MEMBRANES GUIDELINE
• Offer and advise admission to hospital when results are positive
o Consider clinical need for steroids for fetal lung maturity
o Consider suppression of uterine activity if contractions present
o Consider antibiotics to reduce intra-amniotic infection risk
o Consider need for continuous electronic fetal monitoring
o Inform NICU and paediatric team
o Consider expectant management or pre-term delivery based upon holistic,
multi-disciplinary consultation.
6. HAZARDS/SUB-OPTIMAL OUTCOMES
• Infection
• False diagnosis of PPROM
• Unnecessary patient admission
• Additional costs to hospital (each test costs $30)
• Failure to diagnose PPROM
7. DOCUMENTATION
• Integrated clinical notes
• Yellow card
8. EDUCATIONAL NOTES
• Premature Rupture of Membranes (PROM) occurs in 5-10% of pregnancies, is involved in 25-
30% of premature births and accounts for 10% of perinatal deaths.
• Leakage of amniotic fluid is associated with increased infectious morbidity and mortality of
mother and fetus.
• Actim PROM is a fast, reliable test with a reported clinically significant sensitivity of 94.7-
100%
• Actim PROM tests for Insulin-like Growth Factor Binding Protein-1 (IGFBP-1) – the main
protein found in amniotic fluid that is 100-1000 times more concentrated than that in maternal
serum.
• Blood contamination is highly unlikely to affect test results unless there is known copious
bleeding. Urine and seminal fluids do not affect results.
9. RELATED POLICIES/ PROCEDURES/CLINICAL GUIDELINES
• Fetal heart rate monitoring
• Speculum examination for midwives
• Vaginal swab - High
• Preterm labour suppression
• Preterm labour management
10. REFERENCES
• Hill, A., Medina, T. (2006) Preterm Premature Rupture of Membranes: Diagnosis and
Management. American Family Physician. Volume 73: 659-664.
• Chin, P., Kwek, K., Ting, H., Yeo, G. (2007) Comparison of Bedside Test Kits for
Prediction of Preterm Delivery; Phosphorylated Insulin-like Growth Factor Binding
Protein-1 (pIGFBP Test and Fetal Fibronectin Test) Annual of Academia in Medical
Singapore. Volume 36: 399-402.