Prom Management Overview

1. Planning Timeline

• 6+ months out: Set date, secure venue, form committee
• 3–4 months: Book DJ/band, catering, photographer
• 2 months: Open ticket sales, finalize decorations, confirm vendors
• 1 month: Collect final headcounts, arrange transportation, finalize program
• 1–2 weeks: Confirm all vendors, brief chaperones, print materials
• Day of: Setup, run-of-show coordination, breakdown

2. Budget

• Revenue: Ticket sales, sponsorships, fundraisers
• Expenses: Venue, catering, DJ/entertainment, decor, photographer, transportation, awards/prizes

3. Tickets & Attendance

• Online ticket platforms (e.g., Eventbrite, school portals)
• Track sold vs. capacity, guest policies, ID verification

4. Vendors & Logistics

• Venue contracts and insurance
• Catering headcounts and dietary needs
• AV/lighting, florist, photo booth

5. Day-of Coordination

• Arrival/check-in flow
• Run-of-show schedule (dinner, dancing, crowning, etc.)
• Emergency contacts and chaperone assignments

• Build a planning checklist or timeline
• Create a budget spreadsheet
• Draft a vendor contact tracker
• Write a prom proposal or announcement

Management of PROM (Premature Rupture of Membranes)

1. Diagnosis

2. Initial Evaluation After Confirmed PROM

• Estimate gestational age (LMP + ultrasound — beware dolichocephaly and oligohydramnios distorting biometry)
• Assess fetal presentation, fetal well-being (CTG/NST), and amniotic fluid volume
• Evaluate for labor, significant bleeding, and clinical chorioamnionitis
• Check GBS carrier status (culture within 6 weeks, or urine GBS culture in current pregnancy)
• Screen for fetal anomalies that may affect management decisions

3. Management by Gestational Age

A. Term PROM (≥37 weeks)

• Deliver promptly — induction of labor (IOL) is recommended
• Oxytocin induction is preferred; misoprostol is an alternative
• Expectant management (≤12–24 hours) is acceptable but increases infection risk without improving neonatal outcomes
• Chorioamnionitis complicates 9% of term PROM, rising to 24% after >24 hours of rupture
• GBS prophylaxis per carrier status
• Cesarean section is reserved for obstetric indications (malpresentation, fetal distress, etc.)

"There is no substantial fetal benefit to expectant management of pregnancy after membrane rupture at 37 weeks' gestation or later." — Creasy & Resnik's Maternal-Fetal Medicine

B. Preterm PROM — 34 to <37 weeks (Late Preterm)

• Delivery is recommended at 34–36+6 weeks
• Neonatal risks of conservative management (infection, cord accident) outweigh marginal benefits of further maturity at this gestational age
• Antenatal corticosteroids if not previously given (34–36+6 weeks: ACOG supports a single course)
• GBS prophylaxis intrapartum

C. Preterm PROM — 24 to <34 weeks (Conservative/Expectant Management)

Corticosteroids

• Betamethasone 12 mg IM × 2 doses 24 hours apart (or dexamethasone 6 mg IM × 4 doses 12 hours apart)
• Reduces RDS, IVH, necrotizing enterocolitis, and neonatal death
• Indicated for all patients with pPROM at 24–33+6 weeks

Antibiotics (Latency-Prolonging)

• Ampicillin + erythromycin for 7 days (the NICHD/ACOG-recommended regimen):
  • Ampicillin 2g IV q6h × 48h, then Amoxicillin 250mg PO q8h × 5 days
  • Erythromycin 250mg IV q6h × 48h, then 333mg PO q8h × 5 days
• Azithromycin is an acceptable substitute for erythromycin
• Amoxicillin-clavulanate (co-amoxiclav) is contraindicated — associated with increased risk of necrotizing enterocolitis (NEC) in the ORACLE trial

Magnesium Sulfate (Neuroprotection)

• MgSO₄ 4–6g IV loading dose then 1–2 g/hr for neuroprotection
• Indicated if delivery is imminent at <32 weeks — reduces cerebral palsy and gross motor dysfunction

Tocolysis

• Not routinely recommended in pPROM — may prolong latency briefly but does not improve neonatal outcomes and may mask signs of chorioamnionitis
• Short-term use (24–48h) may be considered to allow corticosteroid effect

Monitoring During Conservative Management

• Serial CTG for fetal well-being
• Temperature, WBC, CRP, uterine tenderness — watch for chorioamnionitis
• Ultrasound for AFI, fetal growth, presentation
• DVT prophylaxis: compression stockings; consider LMWH if prolonged bed rest

D. Periviable PROM — 20 to <24 weeks

• Individualized counseling is essential — prognosis is highly variable
• Neonatal survival with conservative management at ≤24 weeks: ~44% overall (14% for PROM before 22 weeks; 58% for 22–24 weeks)
• Major morbidities: RDS (66%), IVH grade 3–4 (5%), sepsis (19%), NEC (4%)
• Pulmonary hypoplasia is a major risk when oligohydramnios persists early in gestation
• Options: expectant management vs. termination of pregnancy — must be discussed openly with the patient
• If expectant, corticosteroids and antibiotics are offered at the threshold of viability

4. Complications to Monitor

5. Indications to Deliver Regardless of Gestational Age

• Clinical chorioamnionitis (fever ≥38°C + uterine tenderness/tachycardia/foul-smelling discharge)
• Fetal distress (non-reassuring CTG)
• Placental abruption
• Umbilical cord prolapse
• Active labor

Summary Algorithm

PROM confirmed
     │
     ├─ ≥37 weeks ────────────────► Induce labor (oxytocin); GBS prophylaxis
     │
     ├─ 34–36+6 weeks ────────────► Deliver; steroids if not given; GBS prophylaxis
     │
     ├─ 24–33+6 weeks ────────────► Conservative management:
     │                               • Betamethasone
     │                               • Ampicillin + erythromycin × 7 days
     │                               • MgSO₄ neuroprotection if <32 wks & delivery imminent
     │                               • Serial monitoring; DVT prophylaxis
     │
     └─ <24 weeks ────────────────► Individualized counseling; expectant vs. termination