What systematic questions should I ask an inpatient mother with preterm premature rupture of membranes (PPROM) to assess gestational age, fluid characteristics, symptoms, obstetric and medical history, and management preferences?

Systematic Assessment Questions for Inpatient Mother with PPROM

Gestational Age and Timing

Begin by establishing precise gestational age at membrane rupture and current gestational age, as these are the most critical determinants of management and prognosis. 1

• Exact gestational age when membranes ruptured (by best obstetric dating using first-trimester ultrasound or last menstrual period) 1
• Date and time of suspected membrane rupture to calculate latency period, as most women deliver within 7 days 2
• Current gestational age to determine if patient is in previable (<24 weeks), periviable (24-26 weeks), or later preterm period, which fundamentally changes management 1, 2

Fluid Characteristics and Confirmation

• Description of fluid loss: amount (gush versus continuous leak), color (clear, blood-tinged, green/brown suggesting meconium, or purulent), and odor (foul-smelling suggests infection) 1
• Ongoing leakage pattern: continuous versus intermittent, and whether it increases with position changes or Valsalva 3
• Any prior testing performed: nitrazine, ferning, Amnisure, or ultrasound findings of oligohydramnios 4

Infection Surveillance Symptoms

Infection can progress rapidly without obvious symptoms, with median time from first signs to maternal death reported as only 18 hours in severe cases, making vigilant symptom assessment critical. 1, 5

• Fever or chills: specifically ask about any temperature ≥38°C (100.4°F), though infection may present without fever especially at earlier gestational ages 1
• Vaginal discharge characteristics: purulent, discolored, or malodorous discharge 1
• Abdominal pain or uterine tenderness: location, severity, and whether constant or intermittent 1
• Contractions or cramping: frequency and intensity 1
• Maternal tachycardia or feeling unwell: subjective sense of illness 1
• Fetal movement changes: decreased or absent fetal movement 1

Hemorrhage and Abruption Assessment

• Vaginal bleeding: any amount, color (bright red versus dark), and timing relative to membrane rupture 1
• Abdominal pain pattern: sudden severe pain suggests abruption 1
• Prior episodes of bleeding during this pregnancy 1

Complete Obstetric History

• Previous preterm births: specifically ask about prior PPROM, as nearly 50% of immediate subsequent pregnancies result in recurrent preterm birth after previable/periviable PPROM 1
• Previous spontaneous preterm deliveries at any gestational age 1
• Cerclage status: whether cerclage is in place, type (prophylactic versus rescue), and placement date 2
• Current pregnancy complications: gestational diabetes, hypertension, placenta previa, growth restriction 3
• Multiple gestation status 3
• Group B Streptococcus (GBS) screening results: positive, negative, or unknown status 5

Medical and Surgical History

• Chronic medical conditions: diabetes, hypertension, autoimmune disorders, renal disease 3
• Prior uterine surgeries: cesarean deliveries, myomectomy, or other procedures that may affect membrane integrity 3
• Immunosuppression or chronic steroid use 1
• Allergies: specifically penicillin allergy and severity (anaphylaxis risk versus rash) for antibiotic selection 5
• Current medications and supplements 3

Social and Support Assessment

• Understanding of diagnosis and prognosis: what has she been told and what does she understand 1
• Support system: partner, family availability for prolonged hospitalization or home monitoring 1
• Distance from hospital: ability to return quickly if complications develop during outpatient management 1
• Ability to perform daily self-monitoring: temperature checks, symptom recognition, and reporting 1
• Cultural or religious considerations affecting management decisions 1

Management Preferences and Decision-Making

All patients with previable and periviable PPROM should be counseled about both abortion care and expectant management options to guide informed decision-making. 1, 2

• Desired management approach: expectant management versus delivery (if gestational age appropriate) 1
• Understanding of neonatal outcomes: at current gestational age, including survival rates (20% at 16-19 weeks, 30% at 20-21 weeks, 41% at 22-23 weeks) and morbidity risks 1
• Resuscitation preferences: at what gestational age would she want neonatal resuscitation attempted 1
• Prior NICU experience with other children or family members 1
• Willingness to accept interventions: antibiotics, corticosteroids, magnesium sulfate, prolonged hospitalization 1
• Understanding that management plans can change: patients have the right to change decisions and should have access to all options throughout care 1

Current Clinical Status

• Vital signs awareness: has she checked her temperature at home, and what was it 1
• Fetal movement pattern today: normal versus decreased 1
• Contractions: presence, frequency, and whether they feel regular 1
• Urinary symptoms: dysuria, frequency, or urgency suggesting concurrent urinary tract infection 3
• Recent exposures: sick contacts or recent illnesses 3

Risk Stratification Factors

• Residual amniotic fluid volume: if ultrasound performed, as higher residual volume is associated with improved perinatal survival 1
• Gestational age at PPROM: later gestational age consistently associated with improved outcomes 1
• Duration of membrane rupture: risk of infection increases continuously with duration, doubling after >4 hours and rising sharply after 18 hours 5