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Version control and change history 
Version Date from Date to Amendment 
1.0 10 May 2004 26 Feb 2007 Original version 
2.0 26 Feb 2007 19 Mar 2007 Reviewed 
3.0 19 Mar 2007 20 Sep 2007 Reviewed 
4.0 20 Sep 2007 30 Dec 2008 Reviewed 
5.0 30 Dec 2008 25 May 2010 Reviewed 
6.0 25 May 2010 18 Oct 2010 Reviewed 
7.0 18 Oct 2010 22 May 2012 Reviewed 
8.0 22 May 2012  20 May 2014 Reviewed 
9.0 20 May 2014 07 Sept 2015 Reviewed 
10.0 07 Sept 2015 Current  

  Department for Health and Ageing, Government of South Australia. All rights reserved. 

 
 

Clinical Guideline 
Preterm Prelabour Rupture of the Membranes Clinical 
Guideline 
 
 
Policy developed by: SA Maternal &amp; Neonatal Clinical Network        
Approved SA Health Safety &amp; Quality Strategic Governance Committee on:   
07 September 2015  
Next review due:   30 September 2018 
 
 
 

 

Summary Clinical practice guideline for the management of preterm 
prelabour rupture of the membranes.  
 
 

Keywords PPROM, preterm prelabour rupture of the membranes, preterm, 
threatened preterm labour, liquor, pooling, speculum, ferning, 
chorioamnionitis, clinical guideline 
 
 

Policy history Is this a new policy?   N 
Does this policy amend or update an existing policy?  Y v9.0 
Does this policy replace an existing policy?  N 
 
 

Applies to All SA Health Portfolio 
All Department for Health and Ageing Divisions 
All Health Networks 
CALHN, SALHN, NALHN, CHSALHN, WCHN, SAAS 
 
 

Staff impact All Staff, Management, Admin, Students, Volunteers 
All Clinical, Medical, Nursing, Allied Health, Emergency, Dental, 
Mental Health, Pathology 
  

  
PDS reference CG142 

Policy                                                                
 

 



South Australian Perinatal Practice Guidelines 

preterm prelabour rupture 
of the membranes 

  Department of Health, Government of South Australia. All rights reserved. 
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         

                                               HealthCYWHSPerinatalProtocol@sa.gov.au Page 1 of 11 Page 1 of 11 

Note 
 
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  

Information in this statewide guideline is current at the time of publication.  

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

 
Explanation of the aboriginal artwork: 
The aboriginal artwork used symbolises the connection to country and the circle shape shows the strong relationships amongst families and the aboriginal culture. The horse shoe shape 
design shown in front of the generic statement symbolises a woman and those enclosing a smaller horse shoe shape depicts a pregnant women. The smaller horse shoe shape in this 
instance represents the unborn child. The artwork shown before the specific statements within the document symbolises a footprint and demonstrates the need to move forward together in 
unison. 

 

    

 

  
Australian Aboriginal Culture is the oldest living culture in the world yet Aboriginal 
people continue to experience the poorest health outcomes when compared to non-
Aboriginal Australians. In South Australia, Aboriginal women are 2-5 times more 
likely to die in childbirth and their babies are 2-3 times more likely to be of low birth 
weight.  The accumulative effects of stress, low socio economic status, exposure to 
violence, historical trauma, culturally unsafe and discriminatory health services and 
health systems are all major contributors to the disparities in Aboriginal maternal 
and birthing outcomes. Despite these unacceptable statistics the birth of an 
Aboriginal baby is a celebration of life and an important cultural event bringing 
family together in celebration, obligation and responsibility. The diversity between 
Aboriginal cultures, language and practices differ greatly and so it is imperative that 
perinatal services prepare to respectively manage Aboriginal protocol and provide a 
culturally positive health care experience for Aboriginal people to ensure the best 
maternal, neonatal and child health outcomes. 
 




South Australian Perinatal Practice Guidelines 

Preterm prelabour rupture of the membranes  
Department of Health, Government of South Australia. All rights reserved. 

 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 04/08/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         

                                               HealthCYWHSPerinatalProtocol@sa.gov.au Page 2 of 11 Page 2 of 11 

PPROM/ Preterm labour assessment  
+ Clinical signs of PPROM 
+ Vaginal loss -note amount, colour, any 
odour 
+ back pain 
+ vaginal spotting or a  show  
+ regular uterine activity 

 

Assessment and management of Preterm prelabour rupture of the membranes 

(PPROM) 

        
         
        
 

    

 

 
 
 
 
 
 
 
 
 
 
 
 

                                                                    
  

+Consider home care 
with outpatient 
management if stable 

Aim for vaginal 
birth with 
caesarean for 
breech 26-32  
weeks 

Greater than 26 weeks 

Paediatric 
assistance at birth 
and neonatal care 
post birth 
 
Less than 26 weeks 

Management as in Preterm labour 
+Consult with Obstetrician re mode of 
delivery 
+Paediatrician review 
 

+Continue antibiotic 
prophylaxis 48 hours 
+Oral eryc 10 days 
+CBP and CRP daily for 3 
days, then twice weekly 
+Consider maintenance 
Tocolysis after 24 hours 

 

With cervical 
length  &lt;2cms 
200 mgs pessary 
daily 
Repeat 20 34 
week 

Active management 

+ tocolysis (if  contracting) 
+ close observation 
+ admit &amp; offer analgesia 
+ administer steroids (&lt; 
34+6 weeks gestation) 
+ commence prophylactic 
antibiotics for GBS 
+transfer as required if 
delivery not imminent 
 

Suppress / expectant 
management 

+ administer steroids &lt; 34 weeks 
gestation (if not already given) 
+ prophylactic antibiotics for GBS (if not 
already given) 
+ start triple antibiotics if signs of 
infection 
+MgSO4 neuroprotection if at least 24

+0
 

and &lt; 30 weeks of gestation (delivery 
expected &lt; 24 hours) 
+ continuous fetal monitoring with CTG 
(depending on gestation) 

 

Sterile speculum examination 
+ exclude cord prolapse 
+ visualise pooling of liquor 
       -take high &amp; low vaginal swabs 
       - obtain a smear &amp; check for ferning 

+ estimate cervical dilatation 
+ remove cervical suture if present 

Physical examination 
+ vital signs  
+ abdominal examination 
+ fetal heart rate +/- CTG 

 

Review history 
+ medical 
+ surgical 
+ obstetric 

PPROM confirmed 
Active preterm labour 
Gestation &gt; 36 weeks  
Evidence of intrauterine infection 

Paediatric 
assistance at birth 

Outpatient management  
+Instruct the woman to take 
her temperature daily 
+Observe PV loss 
+Return for twice weekly 
CTG and CBP &amp; CRP 
+Weekly HVS (results may 
guide use of antibiotics in 
any subsequent labour) 
+Return to hospital if 
reduced fetal movements 

 

Delivery does not occur:  
+further benzylpenicillin 
when labour recurs  

Investigations 
+CRP &amp; CBP 
+MSSU 
+ Ultrasound   assess 
liquor volume and cervical 
length 
 

PPROM confirmed 
+/-Threatened preterm labour 
No signs of chorioamnionitis 
 

PPROM not 
confirmed but good 

history 

+Admit for pad 
checks/early morning 
speculum for pooling of 
liquor 

No evidence 
PPROM 

Home 

Active preterm labour? 

Yes 

No 




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 3 of 11 

Introduction 

? PPROM complicates only 2 % of pregnancies but is associated with 40 % of preterm 

deliveries and can result in significant neonatal morbidity and mortality 

? The three causes of neonatal death associated with PPROM are: 

? Prematurity 

? Sepsis 

? Pulmonary hypoplasia 

? Outcomes for preterm infants depend on place of birth and access to neonatal intensive 

care. Maternal transfer is generally safer than neonatal retrieval if delivery is not imminent 

Definition 

? Rupture of the fetal membranes before 37
+0

 completed weeks of pregnancy (i.e. preterm) 

and before the onset of labour (i.e. prelabour) 

Associated risks of PPROM 

? Preterm labour 

? Cord prolapse 

? Placental abruption 

? Intrauterine infection / amnionitis 

? Pulmonary hypoplasia 

? Limb positioning defects 

? Perinatal mortality 

Initial Assessment 

? History and examination  

? Abdominal palpation to determine fetal size and presentation 

? Speculum examination to: 

? Exclude cord prolapse 

? Visualise pooling of liquor (note presence of vernix)  

? Collect cervical and vaginal microbiological swabs (including GBS) 

? Make a smear to look for ferning on microscopical examination 

? Estimate cervical dilatation 

? Amnicator (nitrazine yellow): a positive reaction results in a blue / purple 

colour on contact (false positive rate of 17 %) 

Transfer or retrieval for access to specialised obstetric and neonatal 

services 

? In units without neonatal facilities suitable for the gestation, consult with tertiary centre. 

Consider maternal transfer if delivery is not imminent or consult with neonatal retrieval 

service if delivery is anticipated 

 

Paediatric 
assistance at birth 
and neonatal care 
post birth 
 
Less than 26 weeks 




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 4 of 11 

Surveillance / Fetal assessment  

? Cardiotocography (CTG) to assess fetal condition  

? Ultrasound to assess liquor volume (and visualise presentation) 

? Consider formal ultrasound for fetal number, weight, presentation, morphology and liquor 

volume 

Laboratory investigations 

? C-Reactive Protein   repeat daily for three days   

? Complete blood picture   repeat daily for three days   

? Low and high vaginal swabs for microscopy and culture 

? Midstream specimen of urine for bacteriology 

Antibiotic prophylaxis 

? Studies show that prophylactic antibiotics prolong pregnancy and reduce maternal and 

neonatal sepsis (Kenyon et al. 2003) 

If there is no evidence of chorioamnionitis 

? Commence antibiotic prophylaxis:  

1. Benzylpenicillin 3 g IV loading dose, then 1.2 g IV every four hours for 48 hours or 
until delivery if this occurs earlier 

? If allergic to penicillin, give clindamycin 600 mg IV in 50   100 mL over at least 

20 minutes every 8 hours, until delivery if this occurs earlier  

2. Oral erythromycin 250 mg 4 times a day for 10 days or until delivery if this occurs 
earlier 

? Further benzylpenicillin prophylaxis, as above, is indicated whenever labour recurs 

If there are signs of chorioamnionitis: 

? The diagnosis of chorioamnionitis relies on the clinical presentation and may be difficult in 

its early manifestations 

? The clinical picture may include maternal fever with two or more of the following: 

? Increased white cell count (&gt; 15 x 109 / L)  

? Maternal tachycardia (&gt; 100 bpm)  

? Fetal tachycardia (&gt;160 bpm)  

? Uterine tenderness  

? Offensive smelling vaginal discharge  

? C-Reactive Protein &gt; 40  

? Consideration should also be given to check for any other site of infection (e.g. urinary or 

respiratory tract) which could cause these changes 

? If in doubt consultation with a senior obstetrician, maternal fetal medicine or infectious 

disease physician should be considered 

? Histological examination of placenta and membranes with evidence of acute inflammation 

may confirm the diagnosis after birth 

 




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 5 of 11 

If signs of chorioamnionitis 

? Ampicillin (or amoxycillin) 2 g IV every 6 hours  

? Gentamicin 5 mg / kg IV daily 

? Metronidazole 500 mg IV every 12 hours 

? If allergic to penicillin, give clindamycin 600 mg IV in 50   100 mL over at least 20 minutes 

every 8 hours AND gentamicin 5 mg / kg IV daily until delivery 

? For information about gentamicin levels, see  Peripartum prophylactic antibiotics  in the A to 
Z index at www.sahealth.sa.gov.au/perinatal 

? Do not inhibit labour, but consider hastening delivery under intravenous antibiotic cover 

? Consider optimal mode of delivery (LSCS versus vaginal birth) on the basis of the findings 

and the anticipated duration until birth 

Postnatal maternal antibiotics 

? If chorioamnionitis, consider treatment with continued: 

? Ampicillin (or amoxycillin) 2g IV every 6 hours for 5 days 

? Gentamicin IV 5 mg / kg as a single daily dose for 5 days 

? Metronidazole 500 mg IV every 12 hours for 5 days 

? May change to oral antibiotics once the woman is afebrile and tolerating oral medication e.g.  

amoxycillin 500 mg every 8 hours and metronidazole 400 mg every 12 hours or amoxycillin / 

clavulanic acid (Augmentin Duo Forte x 1 every 12 hours) for the rest of the 5 days 

? If allergic to penicillin, give metronidazole 400 mg orally every 12 hours for the rest of the 5 
days AND azithromycin 1 g orally as a single dose, repeated after 7 days 

Tocolytics 

? Where contractions are present, nifedipine may be commenced (for further information see 

 nifedipine for preterm labour  in the A to Z index at www.sahealth.sa.gov.au/perinatal) to 

prolong pregnancy for 48 hours while corticosteroid cover is established if there are no other 

signs of chorioamnionitis 

?   Give stat oral dose nifedipine 20 mg 

? Give second oral dose nifedipine 20 mg 30 minutes after first dose (maximum 

is 40 mg in the first hour) 

? Do not give any further nifedipine until 3 hours after the 2
nd

 dose 

? Administer oral nifedipine 20 mg every 3 hours until contractions cease or the 

woman establishes in labour. Prescribe as written (do not prescribe as prn) 

? After 24 hours, medical review is required to determine the dose of 

maintenance treatment with controlled release nifedipine (Adalat
 
 Oros) 2-3 

times per day 

? For further information see  nifedipine for preterm labour  in the A to Z index at 

www.sahealth.sa.gov.au/perinatal  

 

 







South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 6 of 11 

 

Magnesium sulphate for neuroprotection of the fetus 

Controlled trials  

? Show that fetal exposure to magnesium sulphate given before preterm birth has a 

neuroprotective role. The number of women needed to be treated to benefit one baby by 

avoiding cerebral palsy is 63 (Doyle et al. 2009) 

? This systematic review also showed a significant reduction in the rate of gross motor 

dysfunction in early childhood (Doyle et al. 2009) 

Corticosteroids22,23 

? Corticosteroids are effective in preventing adverse perinatal outcomes, most notably 

respiratory distress syndrome, and in increasing the likelihood of neonatal survival
22

 

? Repeated doses of corticosteroids reduce the occurrence and severity of neonatal lung 

disease and the risk of serious health problems in the first few weeks of life
22 

 

Single course Indications 

? Gestational age is between 23
+0

 and 34
+6 

weeks and in PTL 

? Risk of preterm imminent birth 

? Preterm birth is planned or expected within the next seven days  

Dosage 

? Administer IM betamethasone in two doses of 11.4 mg (5.7 mg x 2) 
24 hours apart to the woman  

? If betamethasone is unavailable, give IM dexamethasone in two 
doses of 12 mg, 24 hours apart

22
 

 
? Where appropriate, estimate the risk of preterm birth by considering 

the use of adjunct prediction tests including fetal fibronectin and 
assessment of cervical length 

Repeat 
course(s) 

Indications 

? When the gestational age is 32
+6

 days or less, a repeat antenatal 

corticosteroid dose may be given 7 days or more after the first course 
in women still considered at risk of early preterm birth  

Dosage 

? Either:  A single repeat dose of  IM betamethasone 11.4 mg IM (5.7 

mg x 2)        

? OR A single repeat course of  IM betamethasone in two doses of 11.4 
mg (5.7 mg x 2) 24 hours apart 

? If betamethasone is unavailable, give IM dexamethasone 12 mg 

Further repeat 
single dose(s) 

? Seven days after the first, single, repeat dose (and less than 14 days 
since the first repeat dose), if the woman is still considered to be at 
risk of preterm birth within the next seven days, a further, single, 
repeat dose of antenatal corticosteroids ( IM betamethasone 11.4 mg 
IM [5.7 mg x 2])  can be given 

? Use up to a maximum of three, single, repeat doses only 

? NB:  Do not give any further repeat courses if a single repeat course 

(11.4 mg, as two intramuscular doses, 24 hours apart) of 
betamethasone has been given already 




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 7 of 11 

Indications 

? Neuroprotection of the fetus for women at risk of preterm birth who are at least 24
+0

 weeks 

of gestation and &lt; 30
+0

 weeks of gestation  

? When birth is anticipated within 24 hours or in cases of expected planned delivery as close 

to four hours before expected delivery time and regardless of;  

? plurality  

? why the woman is at risk of preterm birth  

? parity  

? anticipated mode of birth  

? whether antenatal corticosteroids have been given or not  

Dosage and administration 

? See Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus 

in the A to Z index at www.sahealth.sa.gov.au/perinatal 

Counselling 

? The woman and her partner should be counselled by a member of the management team, 

which includes: obstetrician, neonatologist, midwife, and others as appropriate 

Management  

PPROM &lt; 23 weeks gestation 

? Outcomes for extremely preterm infants depend on place of birth and access to neonatal 

intensive care  

? It is important to consult with neonatologists for up to date data to inform clinical decision 

making  

? Parental attitudes must be taken into account in formulating a management plan 

? Continue antibiotic prophylaxis (as above) 

Active management (i.e. allow / encourage birth to proceed) when  

? In established labour  

? Signs of chorioamnionitis are present 

? Significant antepartum haemorrhage is present 

? The woman requests it 

Expectant management  

? Is acceptable when the risk of amnionitis and pulmonary hypoplasia is less than the risk of 

extreme preterm birth and neonatal death 

? If delivery does not occur, further benzylpenicillin prophylaxis is indicated when labour 

recurs  

? Repeat high vaginal swab at weekly intervals; results may guide use of antibiotics in any 

subsequent labour 

? Complete blood picture and C-Reactive Protein twice weekly 

PPROM 23-34 weeks gestation 

? Continue antibiotic prophylaxis (as above) 

? Expectant management until 34 weeks of gestation if GBS positive 






South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 8 of 11 

Active management (i.e. allow / encourage birth to proceed) when 

? In established labour  

? Signs of chorioamnionitis are present 

? Significant antepartum haemorrhage is present 

? Signs of fetal compromise 

? Consider caesarean section if birth is not imminent 

Expectant management may be appropriate in the absence of the above. This 
management should include: 

? Daily medical clinical assessment of the woman 

? Clinical observations twice daily 

? Temperature, maternal pulse, fetal heart rate  

? PV loss 

? Assessment of uterine activity (abdominal pain or tenderness)  

? Involving a neonatologist 

? If delivery does not occur, further benzylpenicillin prophylaxis is indicated when labour 

recurs   

? Facilitating education including: 

? Neonatology review 

? Neonatal intensive care tour 

? Appropriate preterm birth DVD / video 

Surveillance / fetal assessment 

? CTG daily for the first 3-6 days, then twice per week if low risk inpatient or at home 

? CTG should be reconsidered where regular fetal surveillance is required (RCOG 2006) 

? Recommence CTG in the presence of: 

? Regular abdominal pains or tenderness  

? change in amount, colour of liquor 

? Antepartum haemorrhage 

Investigations 

? Complete blood picture (CBP), C- reactive protein (CRP) daily for 3 days 

? Consecutive daily CRP values &gt; 20 mg / L or isolated values &gt; 40 mg / L are suggestive of 

infection 

? Twice weekly after initial assessment  

Vaginal swabs 

? Repeat high vaginal swab at weekly intervals; results may guide use of antibiotics in any 

subsequent labour 

PPROM at 34-37 weeks gestation  

? Continue antibiotic prophylaxis (see above) 

? Studies are currently in progress to establish whether to recommend expectant or active 

management for women with PPROM between 34 to 36 completed weeks of gestation  

  




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 9 of 11 

Active management (i.e. allow / encourage birth to proceed) when 

? In established labour  

? Signs of chorioamnionitis are present 

? Significant antepartum haemorrhage is present 

? If GBS positive, active management after 36 completed weeks of gestation  

? Signs of fetal compromise 

? Consider caesarean section if birth is not imminent 

Expectant management consists of 

? Await spontaneous onset of labour until 36 completed weeks of gestation 

? Continue prophylactic antibiotic treatment   

? Home care may be considered 

Surveillance / fetal assessment 

? CTG daily for the first 3-6 days, then twice per week if low risk inpatient or at home  

? CTG should be reconsidered where regular fetal surveillance is required (RCOG 2006) 

? Recommence CTG in the presence of: 

? Regular abdominal pains or tenderness  

? change in amount, colour of liquor 

? Antepartum haemorrhage 

Home care 

? May be considered for all women after 72 hours of initial hospitalisation if:   

? Singleton pregnancy 

? Cephalic presentation &gt; 23 weeks 

? Easy access to the hospital 

Continue 

? Daily temperature 

? Twice weekly follow up CTG and investigations as an outpatient 

? Return to hospital if reduced fetal movements 




South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 10 of 11 

References 

 
1. Royal College of Obstetricians and Gynaecologists (RCOG).  Preterm prelabour 

rupture of membranes.  RCOG guideline No. 44, October 2010.  Available from URL:  
https://www.rcog.org.uk/ 

2. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. 
Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001058. 
DOI: 10.1002/14651858.CD001058.pub3. (Level I).  Available from URL:  
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001058/pdf_fs.h
tml 

3. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation 
for women at risk of preterm birth. Cochrane Database of Systematic Reviews 2006, 
Issue 3. Art. No.: CD004454. DOI:  10.1002/14651858.CD004454.pub2 (Level I).  
Available form URL:  
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004454/pdf_fs.h
tml 

4. Crowther CA, McKinlay CJD, Middleton P, Harding JE. Repeat doses of prenatal 
corticosteroids for women at risk of preterm birth for improving neonatal health 
outcomes. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: 
CD003935. DOI: 10.1002/14651858.CD003935.pub3. (Level I).  Available from URL:  
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003935/pdf_fs.h
tml 

5. Antenatal Corticosteroid Clinical Practice Guidelines Panel.  Antenatal corticosteroids 
given to women prior to birth to improve fetal, infant, child and adult health:  Clinical 
Practice Guideines.  2015.  Liggins Institute, The University of Auckland, Auckland.  
New Zealand. Available from URL:  www.ligginstrials.org/ANC_CPG 

6. Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for 
women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database of 
Systematic Reviews 2009, Issue 1. Art. No.: CD004661. DOI:  
10.1002/14651858.CD004661.pub3 (Level I).  Available from URL:  
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004661/pdf_fs.h
tml 

7. The Antenatal Magnesium Sulphate for Neuroprotection Guideline Development 
Panel. Antenatal magnesium sulphate prior to preterm birth for neuroprotection of the 
fetus, infant and child: National clinical practice guidelines. Adelaide: The University 
of Adelaide, 2010.  ISBN Print: 978-0-86396-720-7. Available from URL:  
http://www.adelaide.edu.au/arch/ 

8. MIMS Online. MIMS Pharmaceutical Product Information. [online database] Full 
product information Adalat  tablets data version August 2010 [cited 2010 Aug 16].  
Available: MIMS Online.  (Level I). 

9. Enkin M, Keirse MJNC, Neilson J, Crowther C, Duley L, Hodnett E, Hofmeyr J.  A 
guide to effective care in pregnancy and childbirth. 3rd ed. Oxford: Oxford University 
Press; 2000 (Level I). 

10. Ryan G, Oskamp M, Seaward PGR, Kitch T, Barrett T, Brennan B, Salenieks ME, 
O Brien K. Randomized controlled trial of inpatient vs. outpatient management of 
PPROM. Am J Obstet Gynecol 1999; 180: S95 (Level II). 

11. Segal S, Miles A, Clothier B, Parry S, Macones G. Optimal duration of antibiotic 
therapy after PPROM [abstract].  Am J Obstet Gynecol 2002; 187: S72 (Level II).   

  















South Australian Perinatal Practice Guidelines 

preterm prelabour rupture of the membranes 
  
 

ISBN number:   978-1-74243-748-4 
Endorsed by:                         South Australian Maternal &amp; Neonatal Clinical Network 
Last Revised: 07/09/15 
Contact:                                 South Australian Perinatal Practice Guidelines Workgroup at:         
                                               HealthCYWHSPerinatalProtocol@sa.gov.au 

  Page 11 of 11 

Version control and change history 

PDS reference: OCE use only 
 
Version Date from Date to Amendment 

1.0 10 May 2004 26 Feb 2007 Original version 

2.0 26 Feb 2007 19 Mar 2007 Reviewed 

3.0 19 Mar 2007 20 Sep 2007 Reviewed 

4.0 20 Sep 2007 30 Dec 2008 Reviewed 

5.0 30 Dec 2008 25 May 2010 Reviewed 

6.0 25 May 2010 18 Oct 2010 Reviewed 

7.0 18 Oct 2010 22 May 2012 Reviewed 

8.0 22 May 2012  20 May 2014 Reviewed 

9.0 20 May 2014 07 Sept 2015 Reviewed 

10.0 07 Sept 2015 Current  

 

 

Abbreviations 

 
 

bpm Beats per minute 

CBP Complete blood picture  

C Celsius 

CRP C- reactive protein  

CTG Cardiotocography 

et al. And others 

g Gram(s) 

&gt; Greater than 

GBS Group B Streptococcus 

IM Intramuscular 

IV Intravenous 

kg Kilogram/s 

&lt; Less than 

mL Millilitre/s 

mg Milligram/s 

PPROM Preterm prelabour of the membranes  

i.e. That is 



	preterm prelabour rupture of the membranes cover_Sept2015
	Clinical Guideline
	Preterm Prelabour Rupture of the Membranes Clinical Guideline
	Policy developed by: SA Maternal &amp; Neonatal Clinical Network
	Approved SA Health Safety &amp; Quality Strategic Governance Committee on:   07 September 2015
	Next review due:   30 September 2018

	preterm prelabour rupture of the membranes_policy_Sept2015

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