Preterm Prelabour Rupture of Membranes (PPROM)/PRELABOUR Rupture of Membranes (PROM)

Clinical Description

Rupture of the membranes before labour (PROM is >37 weeks gestation while PPR0M is before 37weeks).

Signs and Symptoms

• History of draining liquor / watery vaginal discharge

Treatment

Management if gestation less than 34 weeks

• No digital vaginal examination
• Perform sterile speculum examination and rule out cord prolapse
• Check vital signs and assess fetal heart rate 4 hourly
• Provide a pad and observe for color, amount, and smell of liquor daily

Pharmacological

If at a Health Centre:

• If draining for > 12 hours, commence Erythromycin 250mg 6 hourly for 7 Days
• Give Dexamethasone 6mg IM 12 hourly for 48 hours/ Betamethasone 12mg IM daily for 48 hours
• Refer immediately

At the Hospital

• Manage as described above
• Deliver at 34weeks if there are no signs of chorioamnionitis
• If signs of intra-uterine infection (temperature > 37.50C, uterine tenderness, purulent or offensive liquor,), or fetal distress, plan urgent delivery regardless of gestational age

Management if gestation 34 weeks or greater

• Do sterile speculum exam to confirm draining and rule out cord prolapse
• If membranes have been ruptured for more than 12 hours, give antibiotics:
• Give Ampicillin 2g IV 6 hourly once labour starts.

Or

• Benzylpenicillin 2 MU IV 6 hourly until delivery and continue until 48 hours post delivery.
• Give Erythromycin 250mgs 6 hourly if the patient is not in labour.
• If labour does not begin spontaneously within 24 hours induce labour, if no contraindication to vaginal delivery. Perform c-section if no contraindication.