Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation (Green-top Guideline No. 73)


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the Royal College of Obstetricians, Gynaecologists

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Key recommendations

  • The diagnosis of spontaneous rupture of the membranes is made by maternal history followed by a sterile speculum examination. [Grade D]
  • If, on speculum examination, no amniotic fluid is observed, clinicians should consider performing an insulin-like growth factor-binding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test of vaginal fluid to guide further management. [Grade B]
  • Following the diagnosis of preterm prelabour rupture of the membranes, (PPROM) an antibiotic (preferably erythromycin) should be given for 10 days or until the woman is in established labour (whichever is sooner). [Grade A]
  • Women who have PPROM between 24+0 and 33+6 weeks’ gestation should be offered corticosteroids; steroids can be considered up to 35+6 weeks’ gestation. [Grade A]
  • 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. [Grade D]
  • 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. [Grade A]
  • 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. [Grade A]

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