MANAGEMENT OF PRETERM RUPTURE OF MEMBRANE (PPROM)

Diagnosis Confirmed (Fluid per cervical os or

vaginal pool with positive nitrazine/ferning
test

Ultrasound for Gestasional Age, growth, anomalies, cervical cultures, Chlamydia, Gonorrhea, ano-
vaginal culture, Group B Stretococcus (GBS), Urine Culture
Initial Continous monitoring for labor, fetal status

YES
Chorioamnionitis, Abruptio Placenta, Fetal death, Non reassuring fetal testing or Advanced Labor Deliver

NO

PPROM at PPROM at
Previable PPROM
23-33 6/7 weeks 34-36 6/7 weeks
< 23 Weeks
COUNSELING

Initial monitoring for infection, Conservative management

labor, abruption placentae Serial evaluation for Choriomanionitis,
Labor, abruption, Fetal—well being,
Growth
Administer corticosteroid and antibiotic
RE-COUNSELING Evaluate for persistent Deliver for chorioamnionitis,
olygohydramnions and pulmonary nonreassuring fetal testing, abruption,
hypoplasia with serial ultrasound advanced labor
Deliver at 34 weeks if stable until then
When delivery appears, imminent at < 32
RE-COUNSELING weeks, administer magnesium sulfate for Delivery
Induction With fetal neuroprotection
Misoprostol or
dilatation and If discharged before Viability and
evacuation remains pregnant, readmit at fetal
Intrapartum GBS prophylaxis if norecent negative ano-vaginal culture
viability for conservative
Broad spectrum antibiotics if Chorioamnionitis
management

Adapted From Vincenzo Berghella et al, Obstetric Evidence Based Guidelines Third Edition , 228-229, 2017