management of prelabour rupture of membranes

Last edited 08/2019 and last reviewed 05/2022

Seek Specialist Advice

NICE have issued guidance in this area (1):

Diagnosing preterm prelabour rupture of membranes (P-PROM)

In a woman reporting symptoms suggestive of P-PROM, offer a speculum examination to look for pooling of amniotic fluid and:

• if pooling of amniotic fluid is observed, do not perform any diagnostic test but offer care consistent with the woman having P-PROM
  
  
• if pooling of amniotic fluid is not observed, performg an insulin-like growth factor binding protein-1 test or placental alpha-microglobulin-1 test of vaginal fluid

If the results of the insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1 test are positive, do not use the test results alone to decide what care to offer the woman, but also take into account her clinical condition, her medical and pregnancy history and gestational age, and either:

• offer care consistent with the woman having P-PROM
  
  
• or re-evaluate the woman's diagnostic status at a later time point

If the results of the insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1 test are negative and no amniotic fluid is observed:

• do not offer antenatal prophylactic antibiotics
  
  
• explain to the woman that it is unlikely that she has P-PROM, but that she should return if she has any further symptoms suggestive of P-PROM or preterm labour

Nitrazine must not be used to diagnose P-PROM

Identifying infection in women with P-PROM

• a combination of clinical assessment and tests (C-reactive protein, white blood cell count and measurement of fetal heart rate using cardiotocography) ahould be used to diagnose intrauterine infection in women with P-PROM
  
  
• do not use any one of the following in isolation to confirm or exclude intrauterine infection in women with P-PROM:
  • a single test of C-reactive protein
  • white blood cell count
  • measurement of fetal heart rate using cardiotocography
• if the results of the clinical assessment or any of the tests are not consistent with each other, continue to observe the woman and consider repeating the tests

Guidance regarding antibiotics in PROM, use of magnesium sulphate and maternal steroids are included in the linked items.

Notes (2):

• women presenting with prelabour rupture of the membranes at term should be advised that:
  • risk of serious neonatal infection is 1% rather than 0.5% for women with intact membranes
  • 60% of women with prelabour rupture of the membranes will go into labour within 24 hours

Reference:

• NICE (August 2019).Preterm labour and birth
• NICE (September 2007).Intrapartum care