- History and abdominal examination: remember association of PPROM and malpresentation.
- Perform speculum examination and swabs, after the mother has adopted the left lateral position for 20 minutes. If pool of liquor seen send sample to bacteriology for culture. If there is any dubiety regarding whether liquor has been seen then a registrar shouldrepeat the examination.
Preterm Prelabour Rupture of Membranes (PPROM) (348)
Warning
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Rupture of Membranes prior to 37+0: no evidence of Labour.
- Obtain HVS, LVS and MSSU.
- Do not perform digital examination of cervix unless delivery is planned or imminent.
- Check WCC and CRP.
- If there is no evidence of chorioamnionitis, commence antibiotics. Erythromycin 250mg po qds for 10 days. [Antibiotic treatment following PPROM is effective at prolonging pregnancy and reducing maternal morbidity. There is however, nostatistically proven benefit that their use improves neonatal morbidity or mortality in the long term.]
Subsequent management depends on gestational age
1. <23+6 weeks
- Arrange ultrasound to assess amniotic fluid volume and fetus
- Consultant review
- Discuss with neonatologists if > 22 weeks gestation
2. 23+6 – 37 weeks
- Administer a course of steroids.
- Arrange ultrasound to assess fetal wellbeing.
- Ask neonatologists to see.
- There is no evidence of benefit from the use of tocolytics following preterm premature rupture of membranes, therefore withhold.
If there is evidence of infection or fetal compromise seek senior obstetric opinion, with a view to delivery.
In cases of suspected chorioamnionitis: Sepsis 6 bundle. Commence intravenous antibiotics in accordance with Antibiotic Policy for Obstetric Patients.
If there is no evidence of infection or fetal compromise and the patient is subsequently discharged home, follow-up through Daycare should be arranged.
Timing of delivery is a consultant decision. In women with PPROM and no contraindication to continuing the pregnancy delivery should be planned at 37 weeks gestation.
See separate guideline for the Outpatient management of these patients.