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

Published: 18/06/2019

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This is the first edition of this guideline in the new format, replacing the archived Green-top Guideline no. 44, Preterm Prelabour Rupture of Membranes, and supplementing NICE guideline [NG25], Preterm labour and birth (published November 2015).


Preterm prelabour rupture of membranes (PPROM) complicates up to 3% of pregnancies and is associated with 30-40% of preterm births. PPROM can result in significant neonatal morbidity and mortality, primarily from prematurity, sepsis, cord prolapse and pulmonary hypoplasia. In addition, there are risks associated with chorioamnionitis and placental abruption.

This guideline comprises recommendations relating to the diagnosis, assessment, care and timing of birth of women presenting with suspected PPROM from 24+0 to 36+6 weeks of gestation. It also addresses care in a subsequent pregnancy.

 

Declarations of interest

Dr A Thomson: None declared.

Full disclosure of interests for the developer, Guidelines Committee and peer reviewers are available to view online with the full guideline.

 

Common terms

PPROM, Preterm prelabour rupture of membranes, chorioamnionitis, antibiotics, antenatal corticosteroids

 

Summary graphic

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Diagnosis

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

If, on speculum examination, no amniotic fluid is observed, clinicians should consider performing an insulin-like growth factorbinding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test of vaginal fluid to guide further management.

Assessments

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.

Antibiotics, corticosteroids and magnesium sulfate

An antibiotic (preferably erythromycin) should be given for 10 days or until the woman is in established labour (whichever is sooner) following the diagnosis of PPROM, and corticosteroids and magnesium sulfate, considered or offered.

Expectant management

Women whose pregnancy is complicated by PPROM who have no contraindications to continuing pregnancy should be offered expectant management until 37+0 weeks, as this is associated with better outcomes compared with early birth. Timing of birth should be discussed with each woman on a individual basis.

Remember:

  • Communicate with neonatologists
  • Offer women and partners emotional support
  • Tocolysis is not recommended
  • Care at home may be appropriate for some women

 

Patient information

Information about when your waters break prematurely