Premature Rupture of Membrane
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Diagnosis
Discharge of amniotic fluid before the onset of labor, due to a leak or frank rupture of the amniotic sac.
Differential diagnosis
Urinary incontinence, expulsion of the mucus plug, leucorrhea.
Risks
- Intra - amniotic infection; suspect infection if there is maternal fever, persistent foetal tachycardia or loss of foetal heartbeat, or discoloured amniotic fluid. Never administer a tocolytic agent, no matter what the gestational age, when intraamniotic infection is suspected.
- Pre - term birth, if the rupture occurs before 37 weeks LMP.
Management
- For confirmation in case of doubt, perform speculum + examination: look for fluid pooling in the vagina or leaking part from cervical os, when patient coughs.
- Look for a prolapsed cord. Look for a maternal cause (e.g., urinary tract or vaginal infection) and treat accordingly.
- Admit the patient, advice bed rest and monitor temperature, heart rate, blood pressure, uterine contractions, foetal heart tone, and abnormal amniotic fluid (discolored, purulent) regularly.
- Vaginal examinations: as few as possible, always with sterile gloves and only if the woman is in labor or induction of labor is planned. Antibiotic therapy: For the mother (routinely)
No infection, no labor, and rupture >12hrs
Tab- Amoxcil (amoxicillin) 1gm, 1 tab PO x TDS for 5-7 days.
No infection, labor in progress, and rupture >12 hours
Inj- Penbritin (ampicillin ) IV : initially 2gm , then 1 gm every 4 hours during labor until the child is born , whether the patient received antibiotics beforehand not ; do not continue antibiotics postpartum .
If infection is present, with or without labor , regardless of the duration of the rupture : give
Inj - Penbritin ( ampicillin ) 2 g IV x QID
Inf- Flagyl (metronidazole) 500mg IV x QID
Inj - Delgenta ( gentamicin ) 3- 5mg / kg IM once daily
Continue IV administration for 48 hours after fever disappears then, change to Amoxcil (amoxicillin) 500mg or Augmentin ( Amoxicillin + clavulanic acid ) 625mg + Tab- Flagyl / Klint ( metronidazole ) 400mg 1 tab PO x TDS ( to complete 10 days of treatment )
If there are uterine contractions: Before 34 weeks LMP
Tocolytic agent, except if there are signs of amniotic infection. After 34 weeks LMP, the risk of infection is greater than the risk of preterm birth: do not administer tocolytics.
For ruptures occurring in the seventh and eighth month
Transfer the mother, if possible, to a facility where the preterm infant can receive intensive care.
Induction of labor
In case of infection, induce labor immediately. If there is no infection, consider induction as of 34 weeks LMP if the due date is certain, better as of 37 weeks LMP.
Prepare the fetus for preterm birth
After 26 weeks LMP and before 34 weeks LMP, help lung maturation with dexamethasone IM 6 mg every 12 hours for 48 hours. In case of severe maternal infection, start antibiotic therapy prior to dexamethasone.