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Preterm Prelabour Rupture of Membranes (Green-top Guideline No. 44)

Published: 01/10/2010

This is the first edition of the guideline, published in January 2006 (with minor amendments made in October 2010).

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Preterm prelabour rupture of the membranes (PPROM) complicates only 2% of pregnancies but is associated with 40% of preterm deliveries and can result in significant neonatal morbidity and mortality.

The three causes of neonatal death associated with PPROM are prematurity, sepsis and pulmonary hypoplasia. Women with intrauterine infection deliver earlier than non-infected women and infants born with sepsis have a mortality rate four times higher than those without sepsis. In addition, there are maternal risks associated with chorioamnionitis. There is evidence demonstrating an association between ascending infection from the lower genital tract and PPROM. In women with PPROM about one-third of pregnancies have positive amniotic fluid cultures and studies have shown that bacteria have the ability to cross intact membranes.

The aim of this guideline is to make recommendations relating to the diagnosis, investigation and management of women with PPROM. The guideline evaluates various antenatal tests in helping to predict the fetus at risk from intrauterine infection. The role of prophylactic antibiotics, steroids and tocolytic agents and the optimum gestation to deliver women with pregnancies complicated by PPROM is examined and recommendations are provided based on published evidence.