RCOG Guidelines on management of suspected Preterm Prelabour Rupture of Membranes

Following are the major recommendations:

• The diagnosis of spontaneous rupture of the membranes is made by maternal history followed by a sterile speculum examination demonstrating liquor


• If, on speculum examination, no amniotic fluid is observed, clinicians should consider performing an IGFBP‐1 or PAMG‐1 test of vaginal fluid to guide further management


• The role of ultrasound assessment of amniotic fluid volume is unclear


• A combination of clinical assessment, maternal blood tests (C‐reactive protein and white cell count) and fetal heart rate should be used to diagnose chorioamnionitis in women with PPROM; these parameters should not be used in isolation


• Women should be advised of, and observed for, symptoms of clinical chorioamnionitis (lower abdominal pain, abnormal vaginal discharge, fever, malaise and reduced fetal movements)


• Neonatologists should be informed when the diagnosis of PPROM is confirmed and delivery is anticipated


• Women with PPROM should have the opportunity to meet with a neonatologist antenatally to discuss their baby's care


• Erythromycin should be given for 10 days following the diagnosis of PPROM, or until the woman is in established labour (whichever is sooner)


• In women who have PPROM from 24 ⁺⁰ weeks, antenatal corticosteroids should be:

• offered between 24⁺⁰ and 25⁺⁶ weeks of gestation


• offered between 26⁺⁰ and 33⁺⁶ weeks of gestation


• considered between 34⁺⁰ and 35⁺⁶ weeks of gestation

• In women who have PPROM and are in established labour or having a planned preterm birth within 24 hours, intravenous magnesium sulfate should be offered between 24⁺⁰ and 29⁺⁶ weeks of gestation


• Tocolysis in patients with PPROM is not recommended


• The decision to offer outpatient care to women with PPROM should be made on an individual basis, taking into account markers of delivery latency


• The optimal method of monitoring to predict adverse fetal outcome after PPROM has not been determined


• In PPROM, amnioinfusion is not recommended as part of routine clinical practice


• Women with PPROM and their partners should be offered additional emotional support during pregnancy and postnatally.


• Women whose pregnancy is complicated by PPROM after 24 ⁺⁰ weeks' gestation and who have no contraindications to continuing the pregnancy should be offered expectant management until 37 ⁺⁰ weeks; timing of birth should be discussed with each woman on an individual basis with careful consideration of patient preference and ongoing clinical assessment


• The care of women with PPROM who are known to be colonised with group B streptococcus, is addressed in Green‐top Guideline No. 36


• In a subsequent pregnancy following PPROM, women should be cared for by an obstetrician with an interest in preterm birth

For more details click on the link: https://doi.org/10.1111/1471-0528.15803