Premature Rupture of Membranes (PROM & PPROM) - antibiotic prophylaxis

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ICD10 CODE: O42

Management of PROM >37 weeks

  • Over 90% of patients with PROM go into spontaneous labour within 24 hours
  • Expectant management carries a risk of infection
  • Induction of labour decreases the risk of infection without increasing the C/S delivery rate
  • Expectant management also carries a risk of neonatal issues, Eg., infection, abruptio placenta, foetal distress, foetal restriction deformities, and death
  • Refer all patients to hospital and keep in hospital until delivery

If the membranes have been ruptured for >18 hours and no signs of infection

  • Give prophylactic antibiotics until delivery to help reduce neonatal group B streptococcus infection: Ampicillin 2 g IV every 6 hours or benzylpenicillin 2 MU IV every 6 hours
  • Assess the cervix
  • Refer to HC4 or above (with facilities for emergency obstetric management) for induction with oxytocin

Management of PPROM (<37 weeks)

  • All patients with PPROM should receive prophylactic antibiotics since there is a high risk of infection

Treatment

Refer all patients to hospital, and keep in hospital until delivery

If no signs of infection and pregnancy 24-34 weeks (if gestational age is accurate)

  • Give dexamethasone 6 mg IM every 12 hours for a total of 4 doses (or betamethasone 12 mg IM, 2 doses 24 hours apart)
  • Routine antibiotics: Erythromycin 250 mg every 8 hours plus amoxicillin 500 mg every 8 hours
    • Stop them after delivery if no signs of infection
  • Deliver at 34 weeks

If palpable contractions and blood- stained mucus

  • Suspect preterm labour
  • Hydrate with IV fluids before administering nifedipine
  • Consider administration of tocolytics

-     Tocolytics: Nifedipine 10 mg sublingual tablet placed under the tongue every 15 minutes

if necessary, up to a maximum of 40 mg in the first hour. Then 60-160 mg daily in 3-4 divided doses, adjusted to uterine activity, for max 48 hours

If vaginal bleeding with abdominal pain (intermittent or constant)

Suspect and treat as abruptio placentae (see section 16.3.6 of Uganda Clinical Guidelines)

If signs of infection (fever, foul-smelling vaginal discharge)

  • Give antibiotics as for Amnionitis
  • Deliver immediately

Caution - Do not use steroids in the presence of infection.