Preterm Prelabour Rupture of Membranes (PPROM) Outpatient Management (326)

(After a period of 48-72 hours as an inpatient)

Prior to discharge, women should be advised of the signs and symptoms of chorioamnionitis and under what circumstances they should seek specialist advice. Give them the patient information leaflet.

The following women are unlikely to be suitable for outpatient management:

• Non-cephalic presentation
• Living somewhere far from the unit
• SNIPS issues that may prevent compliance
• Difficulties with transportation

Woman should be reviewed twice per week in Day Care. The following should be reviewed:

• Well being of woman, colour of liquor, any pain, fetal movements
• Checks observations, including temperature (if HR >100bpm, temperature < 36°c or > 38°c, RR>20 or O2 sats<94% on/air then registrar review required).
• Examine abdomen
• Check WCC/CRP
• Check fetal heart(110-160bpm) – if any concerns and ≥26 +0 weeks, commence CTG

Perform fortnightly ultrasound scans for growth, LV and umbilical Doppler (unless concerns prompt more frequent monitoring)

CTG monitoring is not required unless there are concerns regarding fetal movement, maternal wellbeing, fetal growth or umbilical artery Doppler

If there are concerns regarding the above or there is suspicion of chorioamnionitis, then senior obstetric opinion should be sought

Vaginal swabs are performed at diagnosis and if woman is symptomatic (discharge, pyrexia etc.)

Planned delivery should be considered at 37 weeks if no contraindication to continuing the pregnancy. This is a consultant decision and arrangements should be put in place to facilitate consultant review in order for a plan to be documented.