Prelabor Rupture of Membranes

Publication Date: March 1, 2020
Last Updated: March 14, 2022

Recommendations

Patients with preterm PROM before 34 0/7 weeks of gestation should be managed expectantly if no maternal or fetal contraindications exist.
574
A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks of gestation and 33 6/7 weeks of gestation and may be considered for pregnant women who are at risk of preterm birth within 7 days, including for those with ruptured membranes, as early as 23 0/7 weeks of gestation.
574
A single course of corticosteroids is recommended for pregnant women between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation at risk of preterm birth within 7 days and who have not received a previous course of antenatal corticosteroids if proceeding with induction or delivery in no less than 24 hours and no more than 7 days.
574
Women with preterm PROM before 32 0/7 weeks of gestation who are thought to be at risk of imminent delivery should be considered candidates for fetal neuroprotective treatment with magnesium sulfate.
574
To reduce maternal and neonatal infections and gestational-age-dependent morbidity, a 7-day course of therapy of latency antibiotics with a combination of intravenous ampicillin and erythromycin followed by oral amoxicillin and erythromycin is recommended during expectant management of women with preterm PROM who are at less than 34 0/7 weeks of gestation. Some centers have replaced the use of erythromycin with azithromycin in situations in which erythromycin is not available or not tolerated, and this substitution is a suitable alternative.
574
Women with preterm PROM and a viable fetus who are candidates for intrapartum group B streptococci (GBS) prophylaxis should receive intrapartum GBS prophylaxis to prevent vertical transmission regardless of earlier antibiotic treatments.
574
For women with PROM at 37 0/7 weeks of gestation or more, if spontaneous labor does not occur near the time of presentation in those who do not have contraindication to labor, labor induction should be recommended, although the choice of expectant management for a short period of time may be appropriately offered.
574
Either expectant management or immediate delivery in patients with PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation is a reasonable option, although the balance between benefit and risk, from both maternal and neonatal perspectives, should be carefully considered, and patients should be counseled clearly. Care should be individualized through shared decision making, and expectant management should not extend beyond 37 0/7 weeks of gestation. Latency antibiotics are not appropriate in this setting.
574
In the setting of ruptured membranes with active labor, although tocolytic therapy has not been shown to prolong latency or improve neonatal outcomes, data are limited. Tocolytic agents can be considered in preterm PROM for steroid benefit to the neonate, especially at earlier gestational ages, or for maternal transport but should be used cautiously and avoided if there is evidence of infection or abruption. Tocolytic therapy is not recommended in the setting of preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.
574
Given the potential benefit of progesterone therapy, women with a single gestation and a prior spontaneous preterm birth (due to either labor with intact membranes or preterm PROM) should be offered progesterone supplementation as clinically indicated to reduce the risk of recurrent spontaneous preterm birth.
574
The diagnosis of membrane rupture typically is confirmed by conventional clinical assessment, which includes the visualization of amniotic fluid passing from the cervical canal and pooling in the vagina, a simple pH test of vaginal fluid, or arborization (ferning) of dried vaginal fluid, which is identified under microscopic evaluation.
574
The outpatient management of preterm PROM with a viable fetus has not been studied sufficiently to establish safety and, therefore, is not recommended. Periviable PROM may be considered for home care after a period of assessment in the hospital.
574

Recommendation Grading

Overview

Title

Prelabor Rupture of Membranes

Authoring Organization

Publication Month/Year

March 1, 2020

Last Updated Month/Year

January 9, 2023

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Hospital

Intended Users

Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D050498 - Live Birth, D047928 - Premature Birth

Keywords

Preterm birth, PROM