Premature Rupture of Membranes

🏥 PPROM QUICK REFERENCE

Premature Preterm Rupture of Membrane - Bedside Card

2-3%

of all pregnancies affected

33%

of preterm births

10-32%

recurrence risk

24-37w

typical presentation

🔍 DIAGNOSIS

• Sterile speculum exam (GOLD STANDARD)
• Look for pooled fluid in posterior fornix
• Nitrazine test (alkaline = blue-green)
• Ferning test (salt crystals)
• Ultrasound (AFI assessment)
• PAMG-1 if equivocal

⚠ SCREEN FOR COMPLICATIONS

• Chorioamnionitis (fever + signs)
• Placental abruption (bleeding + pain)
• Cord prolapse (cord visible)
• Fetal distress (abnormal CTG)

Any complication → STAT DELIVERY

📍 MANAGEMENT BY GA

• Less than 22-24w: Previable (shared decision)
• 22-34w: EXPECTANT management
• 34-37w: Depends on GBS status
• 37w and above: Deliver (term reached)

💊 MEDICATIONS - ALL GA LESS THAN 34-35w

Corticosteroids

Betamethasone 12mg IM x2 at 24h apart

Antibiotics (latency)

Ampicillin + Macrolide x7-10 days

GBS prophylaxis (labor)

Penicillin G or Ampicillin IV

✓ MATERNAL SURVEILLANCE

• Daily temp monitoring
• Daily symptom check
• Weekly speculum exams (NO digital)
• Return if fever/pain/discharge/decreased FM
• Bed rest NOT recommended

✓ FETAL SURVEILLANCE

• Continuous CTG if greater than 24w viable
• Daily fetal movement counting
• Twice-weekly NST/CTG minimum
• Ultrasound q2-4 weeks
• Assess growth, AFI, placenta

⏱ IMMEDIATE STEPS

• Confirm diagnosis (sterile speculum)
• Vital signs + obstetric exam
• Fetal assessment (CTG if viable)
• Screen for complications
• CBC + cultures + GBS swab
• Ultrasound: confirm, assess GA, AFI
• START corticosteroids STAT

🏥 ADMISSION CRITERIA

• Any PPROM less than 34 weeks (typically)
• First 48-72 hours minimum
• Complications (fever, bleeding, distress)
• Unreliable or no home support
• GA less than 28 weeks (almost always)

🚨 RED FLAGS - DELIVER IMMEDIATELY

Chorioamnionitis:
Fever + tachycardia + tenderness + discharge

Abruption:
Bleeding + pain + shock signs

Cord Prolapse:
Cord visible through cervix

Fetal Distress:
Late decelerations + bradycardia

📋 DOCUMENTATION ESSENTIALS

Must include: Diagnosis method + results • Gestational age (LMP or US) • Red flag assessment • Complications screening • Medications given with times • Monitoring plan • Counseling and informed consent • Follow-up arranged

Version 1.0 | June 2026 | Swaraj Hospital and Research Institute, Bolangir

For complete details, refer to full PPROM Protocol Document