Management of Term Premature Rupture of Membranes
For term premature rupture of membranes (PROM), prompt delivery is recommended to reduce the risk of maternal and neonatal infection. 1
Definition and Clinical Significance
- Term PROM is defined as rupture of fetal membranes after 37 weeks of gestation but before the onset of labor 2
- PROM causes approximately one-third of all preterm deliveries and complicates about 3% of pregnancies 2
Diagnosis
- Diagnosis is primarily clinical, based on visualization of amniotic fluid leaking from the cervical os during sterile speculum examination 2
- In doubtful cases, detection of biochemical markers such as IGFBP-1 or PAMG-1 (Amnisure test, Actim test) is recommended for confirmation 2, 3
Management Algorithm for Term PROM
Immediate Assessment
- Confirm diagnosis through sterile speculum examination 2
- Evaluate for signs of infection, placental abruption, and fetal well-being 4
- Assess fetal presentation and estimated fetal weight 4
Timing of Delivery
- When PROM occurs at term, labor typically ensues spontaneously or should be induced within 12-24 hours 5
- Delivery is indicated when membranes are prematurely ruptured at term as stated in the FDA label for oxytocin 1
Induction Methods
- Oxytocin is indicated for the initiation of labor when membranes are prematurely ruptured and delivery is indicated 1
- Both oxytocin and prostaglandins are acceptable options for labor induction in PROM 3
Antibiotic Considerations
- Routine antibiotic prophylaxis is not recommended for term PROM unless there are specific risk factors such as:
Monitoring During Labor
- Regular assessment of maternal vital signs to detect early signs of intraamniotic infection 6
- Continuous fetal heart rate monitoring to detect fetal tachycardia, which may indicate infection 6
- Monitor for signs of chorioamnionitis: maternal temperature ≥38°C, maternal tachycardia, purulent cervical discharge, uterine tenderness 6
Special Considerations
Signs of Intraamniotic Infection
- Prompt intervention is necessary if signs of infection develop 6
- Clinical diagnosis of infection should not be delayed due to absence of maternal fever 6
- Delaying intervention when signs of infection are present can lead to serious maternal complications including sepsis 6
Mode of Delivery
- Cesarean delivery should be performed according to the usual obstetrical indications, not solely based on PROM status 3
Common Pitfalls to Avoid
- Delaying induction beyond 24 hours after membrane rupture, which increases risk of intraamniotic infection 5
- Failing to recognize early signs of infection, which may present without maternal fever 6
- Unnecessary cesarean delivery based solely on PROM status rather than standard obstetrical indications 3