Approach to prophylaxis for PPROM

Preterm prelabour rupture of membranes (PPROM) (ie membrane rupture before 37 weeks’ gestation and before the onset of uterine contractions) is the commonest cause of preterm birth. Antibiotic prophylaxis for PPROM prolongs pregnancy and reduces maternal and neonatal morbidity. However, antibiotic prophylaxis for PPROM does not appear to reduce perinatal mortality or improve longer-term outcomes. The use of antibiotic prophylaxis in preterm labour in the absence of membrane rupture is not supported by evidence.

PPROM may be preceded by infection. For women with PPROM, exclude urinary tract infection and sexually transmitted infections (eg Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis) and screen for Streptococcus agalactiae (group B streptococcus) carriage (if this has not already occurred).

For PPROM with suspected or confirmed intra-amniotic infection (chorioamnionitis) (ie fever [38°C or more] with other clinical manifestations such as uterine tenderness and purulent amniotic fluid), treat as for intra-amniotic infection (chorioamnionitis).

For PPROM without suspected or confirmed intra-amniotic infection (chorioamnionitis):

• If delivery is imminent or gestational age is more than 36 weeks, PPROM prophylaxis is not required. If indicated, give prophylaxis for group B streptococcus—see Prevention of neonatal Streptococcus agalactiae (group B streptococcus) disease.
• If delivery is not imminently planned and gestational age is at or before 36 weeks, give PPROM prophylaxis.