Preterm prelabour rupture of membranes (PPROM)

O42.0-1/O42.9

DESCRIPTION

Rupture of the membranes before 37 'weeks’ gestation.
Confirmed with a sterile speculum examination demonstrating leakage of amniotic fluid.
If there is clinical uncertainty test for pH – liquor is alkaline.
Avoid digital vaginal examination.

MEDICINE TREATMENT

To improve fetal lung maturity at 26–34 weeks: (Z29.2)

  • Betamethasone, IM, 12 mg, 2 doses 12 hours apart.

LoEI [32]

Initiate antibiotic therapy: (Z29.2)

  • Amoxicillin, oral, 500 mg 8 hourly, until referral.

LoEIII [33]

AND

  • Metronidazole, oral, 400 mg 8 hourly, until referral.

LoEIII [34]

Severe penicillin allergy: (Z88.0)

  • Azithromycin, oral, 500 mg daily, until referral.

LoEIII

AND

  • Metronidazole, oral, 400 mg 8 hourly, until referral.

REFERRAL

All cases, but refer urgently if PPROM < 34 weeks.