RCOG guideline on preterm prelabour rupture of membranes

  • RCOG
  • 18 Jun 2019

  • curated by Pavankumar Kamat
  • UK Clinical Digest
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  • The Royal College of Obstetricians and Gynaecologists (RCOG) has issued new recommendations for pertaining to the diagnosis, assessment, care and timing of birth of women presenting with suspected preterm prelabour rupture of membranes (PPROM) from 24+0 to 36+6 weeks of gestation.

Why this matters

  • PPROM is associated with complications in up to 3% of pregnancies and preterm birth in 30-40% of pregnancies.
  • It has a significant role in neonatal morbidity and mortality, predominantly from pre-maturity, sepsis, cord prolapse and pulmonary hypoplasia.

Key recommendations

  • Spontaneous rupture of the membranes should be diagnosed on the basis of maternal history followed by a sterile speculum examination.
  • If amniotic fluid is not observed on speculum examination, clinicians should consider conducting an insulin-like growth factor-binding protein 1 or placental alpha microglobulin-1 test of vaginal fluid to assist further management.
  • After diagnosis of PPROM, an antibiotic (ideally erythromycin) should be administered for 10 days or until confirmed labour (whichever occurs earlier).
  • Corticosteroids should be offered to women who have PPROM between 24+0 and 33+6 weeks of gestation; steroids can be considered up to 35+6 weeks of gestation.
  • A combination of clinical assessment, maternal blood tests (C-reactive protein and white blood cell count) and foetal heart rate should be used for diagnosis of chorioamnionitis in women with PPROM; however, these parameters should not be used separately.
  • If PPROM complicates pregnancy after 24+0 weeks of gestation and there are no contraindications to the continuation of pregnancy, expectant management should be offered until 37+0 weeks. In such a scenario, the timing of birth should be individually discussed with the woman after considering patient preference and ongoing clinical assessment.
  • If women with PPROM are in confirmed labour or have a preterm birth planned within 24 hours, intravenous magnesium sulphate should be offered between 24+0 and 29+6 weeks of gestation.