RCOG Guidelines for PPROM
I do not have access to specific Royal College of Obstetricians and Gynaecologists (RCOG) guidelines in the evidence provided to me. The evidence I have consists primarily of American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) guidelines, along with one comparative review that mentions RCOG guidelines exist but does not detail their content 1.
What I Can Tell You About Available Guidelines
The most recent and highest quality guidelines for PPROM management come from the Society for Maternal-Fetal Medicine (SMFM) 2024, endorsed by ACOG, which provides comprehensive evidence-based recommendations for previable and periviable PPROM management 2.
Key Management Recommendations from Available Guidelines:
Gestational Age-Based Approach:
At <20 weeks (previable): Abortion care should be offered as the primary option due to extremely high maternal risks and minimal chance of fetal survival 3, 4.
At 20-23 6/7 weeks (periviable): Individualized counseling about maternal and fetal risks is essential; both abortion care and expectant management should be discussed; antibiotics can be considered if expectant management is chosen (GRADE 2C) 2.
At ≥24 weeks: Antibiotics are strongly recommended (GRADE 1B); expectant management with close monitoring is appropriate 2, 3.
Antibiotic Regimen:
Administer a 7-day course: IV ampicillin 2g every 6 hours plus erythromycin 250mg IV every 6 hours for 48 hours, followed by oral amoxicillin 250mg every 8 hours plus erythromycin 333mg every 8 hours for 5 days 3, 5.
Never use amoxicillin-clavulanic acid due to increased risk of neonatal necrotizing enterocolitis 3, 4, 5.
Antenatal Corticosteroids:
Do not administer until neonatal resuscitation and intensive care would be pursued by both the healthcare team and patient (GRADE 1B) 2, 6.
At ≥24 weeks with anticipated delivery within 7 days: Give betamethasone 12mg IM, two doses 24 hours apart 3, 6.
Magnesium Sulfate:
- Administer when delivery is anticipated before 32 weeks and neonatal resuscitation is planned for fetal neuroprotection 3, 4.
Monitoring:
Weekly outpatient assessment of maternal vital signs, fetal heart rate, physical examination, and laboratory evaluation for leukocytosis 3, 4.
Immediate delivery indicated for: signs of infection (fever, uterine tenderness, fetal tachycardia, purulent discharge), placental abruption, or nonreassuring fetal status 3, 7.
Regarding RCOG Guidelines Specifically:
The comparative review notes that RCOG has published guidelines on PPROM, but the specific content is not provided in the evidence available to me 1. To obtain the actual RCOG PPROM guidelines PDF, you would need to visit the RCOG website directly at www.rcog.org.uk and search their guidelines section, or contact RCOG directly for the most recent version.
The review does note that while there is overall agreement among major guidelines (ACOG, RCOG, and SOGC) on diagnosis and basic management principles, there are discrepancies regarding optimal timing of delivery in the late preterm period and recommendations on inpatient versus outpatient management 1.