diagnosing preterm premature rupture of membranes (P - PROM)

Last edited 08/2019 and last reviewed 01/2023

Diagnosing preterm prelabour rupture of membranes (P-PROM)

Seek expert advice

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.

Reference:

• NICE (August 2019).Preterm labour and birth