Preterm prelabour rupture of the membranes (PPROM) occurs in around 2% of pregnancies but is associated with around 40% of preterm deliveries

PC

• A sudden gush of fluid from the vagina.
• Leaking of fluid from the vagina.
• A feeling of wetness in vagina or underwear.

Investigations

Clinical diagnosis: A sterile speculum examination should be performed (to look for pooling of amniotic fluid in the posterior vaginal vault) but digital examination should be avoided due to the risk of infection.

Labs:

*Where there is doubt over the diagnosis

• Actim-PROM vaginal swab for Insulin-like growth factor-binding protein-1 (IGFBP-1)
  • a protein present in high concentrations in amniotic fluid
• Placental alpha-microglobin-1 (PAMG-1) is a similar alternative to IGFBP-1

Imaging:

• Ultrasound may also be useful to show oligohydramnios.

Management

• admission
• regular observations to ensure chorioamnionitis is not developing
  • oral erythromycin should be given for 10 days to prevent this
• antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
• delivery should be considered at 34 weeks of gestation - there is a trade-off between increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progress