Premature Rupture of Membranes (PROM & PPROM) - antibiotic prophylaxis
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Management of PROM >37 weeks
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 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.