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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Preterm prelabour rupture of membranes

Obstetrics and gynaecology · UK scope · Sources checked 7 Sept 2026 · Clinical review pending

RapidFull
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PPROM with infection or fetal compromise

Fever, maternal deterioration, uterine tenderness, offensive fluid, bleeding or an abnormal fetal heart rate may make continued pregnancy unsafe.

Action: Arrange immediate senior maternity review, assess for sepsis and cord prolapse, start indicated treatment and coordinate birth rather than waiting to complete prophylaxis or fetal-maturation medicines.

Synopsis

Confirm membrane rupture before 37 weeks, detect infection or fetal danger, and balance safe pregnancy prolongation against the need for birth.

  • PPROM is rupture of the membranes before labour and before 37 completed weeks of pregnancy.
  • Offer a sterile speculum examination: visible pooling of amniotic fluid is sufficient to follow the PPROM pathway without another diagnostic test.
  • If pooling is absent, use an appropriate IGFBP-1 or PAMG-1 membrane-rupture test and interpret a positive result with the whole clinical picture.
  • Do not use nitrazine or a single inflammatory marker to establish or exclude the diagnosis or intrauterine infection.
  • Offer oral erythromycin 250 mg four times daily for up to 10 days or until established labour, whichever occurs first; avoid co-amoxiclav prophylaxis.
  • Offer expectant care when safe, generally towards 37+0 weeks, with individual discussion after 34 weeks and earlier birth for infection, compromise or another indication.
  • After 34+0 and before 37+0 weeks, a positive GBS test during the current pregnancy supports offering immediate induction or caesarean birth under NICE.

Key red flags

A visible or palpable cord after fluid loss is an obstetric emergency requiring immediate relief of compression and urgent delivery planning.

Maternal systemic illness, worsening abdominal pain, bleeding or reduced fetal movement after membrane rupture needs urgent hospital reassessment.

Investigation priorities

01
Sterile speculum examinationFirst step

Look directly for pooled fluid and assess the cervix and vaginal discharge.

Management branches

ConfirmEstablish whether membranes have ruptured

A patient before 37 weeks reports a gush or recurrent watery leakage.

  1. Take the leakage and symptom history, assess maternal observations and fetal condition, and perform a consented sterile speculum examination.
  2. Treat visible pooling as PPROM; if pooling is absent, obtain a suitable rupture biomarker and integrate its result with the clinical picture.
  3. Explain uncertainty when findings disagree and arrange reassessment, avoiding automatic prolonged antibiotics after a negative low-risk assessment.

Key medicines

Erythromycin for PPROM latency prophylaxisGive erythromycin 250 mg orally four times daily for a maximum of 10 days, stopping earlier if established labour begins.Check allergy, QT-prolonging interactions and intolerance. Consider an oral penicillin if erythromycin is unsuitable; do not choose co-amoxiclav for this prophylactic indication.
Benzylpenicillin for indicated intrapartum GBS prophylaxisA standard UK regimen is benzylpenicillin 3 g intravenously initially, then 1.5 g intravenously every 4 hours until birth, when intrapartum GBS prophylaxis is indicated and penicillin can be used.Assess the nature of any penicillin allergy and use the appropriate alternative pathway; suspected maternal infection needs treatment broad enough for the likely source rather than prophylaxis alone.
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Sources and review status5 sources · checked 7 Sept 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

  • NICE NG25 PPROM recommendations
  • RCOG Green-top 73 preterm prelabour rupture of membranes
  • NICE NG207 timing of birth after membrane rupture
  • NICE NG195 neonatal infection prevention
  • RCOG Green-top 36 intrapartum GBS antibiotic prophylaxis

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom