Care of Women Presenting with Suspected
Preterm Prelabour Rupture of Membranes
from 24+0 Weeks of Gestation
Green-top Guideline No. 73
June 2019
Please cite this paper as: Thomson AJ, on behalf of the Royal College of Obstetricians and Gynaecologists. Care of
Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation. BJOG
2019; https://doi.org/10.1111/1471-0528.15803.
Tweetable abstract: #GreenTopGuideline No. 73 recommends how to diagnose & care for suspected #PPROM from
24 + 0 to 36 + 6 weeks of gestation.
, DOI: 10.1111/1471-0528.15803 RCOG Green-top Guidelines
Care of Women Presenting with Suspected Preterm Prelabour Rupture of
Membranes from 24+0 Weeks of Gestation
AJ Thomson on behalf of the Royal College of Obstetricians and Gynaecologists
Correspondence: Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG.
Email:
1. Key recommendations
The diagnosis of spontaneous rupture of the membranes is made by maternal history followed by a
sterile speculum examination. [Grade D]
If, on speculum examination, no amniotic fluid is observed, clinicians should consider performing an
insulin-like growth factor-binding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test
of vaginal fluid to guide further management. [Grade B]
Following the diagnosis of preterm prelabour rupture of the membranes, (PPROM) an antibiotic
(preferably erythromycin) should be given for 10 days or until the woman is in established labour
(whichever is sooner). [Grade A]
Women who have PPROM between 24+0 and 33+6 weeks’ gestation should be offered corticosteroids;
steroids can be considered up to 35+6 weeks’ gestation. [Grade A]
A combination of clinical assessment, maternal blood tests (C-reactive protein and white cell count) and
fetal heart rate should be used to diagnose chorioamnionitis in women with PPROM; these parameters
should not be used in isolation. [Grade D]
Women whose pregnancy is complicated by PPROM after 24+0 weeks’ gestation and who have no
contraindications to continuing the pregnancy should be offered expectant management until 37+0 weeks;
timing of birth should be discussed with each woman on an individual basis with careful consideration of
patient preference and ongoing clinical assessment. [Grade A]
In women who have PPROM and are in established labour or having a planned preterm birth within 24 hours,
intravenous magnesium sulfate should be offered between 24+0 and 29+6 weeks of gestation. [Grade A]
2. Background and scope
Preterm prelabour rupture of membranes (PPROM) complicates up to 3% of pregnancies and is associated with 30–
40% of preterm births.1 PPROM can result in significant neonatal morbidity and mortality, primarily from
prematurity, sepsis, cord prolapse and pulmonary hypoplasia. In addition, there are risks associated with
chorioamnionitis and placental abruption.2
The median latency after PPROM is 7 days and tends to shorten as the gestational age at PPROM advances.3,4
This guideline comprises recommendations relating to the diagnosis, assessment, care and timing of birth of women
presenting with suspected PPROM from 24+0 to 36+6 weeks of gestation. It also addresses care in a subsequent
pregnancy. An infographic and audio version to supplement this guideline are available online (Infographic S1,
RCOG Green-top Guideline No. 73 2 of 15 ª 2019 Royal College of Obstetricians and Gynaecologists
Preterm Prelabour Rupture of Membranes
from 24+0 Weeks of Gestation
Green-top Guideline No. 73
June 2019
Please cite this paper as: Thomson AJ, on behalf of the Royal College of Obstetricians and Gynaecologists. Care of
Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation. BJOG
2019; https://doi.org/10.1111/1471-0528.15803.
Tweetable abstract: #GreenTopGuideline No. 73 recommends how to diagnose & care for suspected #PPROM from
24 + 0 to 36 + 6 weeks of gestation.
, DOI: 10.1111/1471-0528.15803 RCOG Green-top Guidelines
Care of Women Presenting with Suspected Preterm Prelabour Rupture of
Membranes from 24+0 Weeks of Gestation
AJ Thomson on behalf of the Royal College of Obstetricians and Gynaecologists
Correspondence: Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG.
Email:
1. Key recommendations
The diagnosis of spontaneous rupture of the membranes is made by maternal history followed by a
sterile speculum examination. [Grade D]
If, on speculum examination, no amniotic fluid is observed, clinicians should consider performing an
insulin-like growth factor-binding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test
of vaginal fluid to guide further management. [Grade B]
Following the diagnosis of preterm prelabour rupture of the membranes, (PPROM) an antibiotic
(preferably erythromycin) should be given for 10 days or until the woman is in established labour
(whichever is sooner). [Grade A]
Women who have PPROM between 24+0 and 33+6 weeks’ gestation should be offered corticosteroids;
steroids can be considered up to 35+6 weeks’ gestation. [Grade A]
A combination of clinical assessment, maternal blood tests (C-reactive protein and white cell count) and
fetal heart rate should be used to diagnose chorioamnionitis in women with PPROM; these parameters
should not be used in isolation. [Grade D]
Women whose pregnancy is complicated by PPROM after 24+0 weeks’ gestation and who have no
contraindications to continuing the pregnancy should be offered expectant management until 37+0 weeks;
timing of birth should be discussed with each woman on an individual basis with careful consideration of
patient preference and ongoing clinical assessment. [Grade A]
In women who have PPROM and are in established labour or having a planned preterm birth within 24 hours,
intravenous magnesium sulfate should be offered between 24+0 and 29+6 weeks of gestation. [Grade A]
2. Background and scope
Preterm prelabour rupture of membranes (PPROM) complicates up to 3% of pregnancies and is associated with 30–
40% of preterm births.1 PPROM can result in significant neonatal morbidity and mortality, primarily from
prematurity, sepsis, cord prolapse and pulmonary hypoplasia. In addition, there are risks associated with
chorioamnionitis and placental abruption.2
The median latency after PPROM is 7 days and tends to shorten as the gestational age at PPROM advances.3,4
This guideline comprises recommendations relating to the diagnosis, assessment, care and timing of birth of women
presenting with suspected PPROM from 24+0 to 36+6 weeks of gestation. It also addresses care in a subsequent
pregnancy. An infographic and audio version to supplement this guideline are available online (Infographic S1,
RCOG Green-top Guideline No. 73 2 of 15 ª 2019 Royal College of Obstetricians and Gynaecologists
