Premature Rupture of Membranes

Rupture of the fetal membranes at or after 37 weeks gestation, before the onset of labor (term PROM), distinct from PPROM above.

Occurs in roughly 8 to 10% of term pregnancies. The majority go into spontaneous labor within 24 hours.

A gush or persistent leakage of clear fluid at term, without regular painful contractions.

Sterile speculum examination confirming pooling of amniotic fluid; digital vaginal examination is avoided until labor is established or induction is planned, to minimize infection risk.

Fetal presentation and wellbeing assessed by palpation and CTG.

• Expectant management for up to 24 hours is a reasonable option for women declining immediate induction, given spontaneous labor occurs in the large majority within this window, with maternal temperature monitored 4 hourly and advice to report any change in fetal movements, fever, or offensive discharge
• Induction of labor is offered from the time of presentation, and generally recommended if labor has not begun within 24 hours, given a rising infection risk with prolonged rupture: oxytocin infusion, titrated per local protocol, with or without preceding cervical ripening (vaginal prostaglandin E2 or a mechanical method) depending on cervical favorability
• Group B streptococcus prophylaxis in labor as per Preterm Labour entry, if status positive or unknown with additional risk factors
• Antibiotics are not given prophylactically for uncomplicated term PROM without signs of infection
• Continuous or intermittent fetal monitoring per local intrapartum protocol once labor is established
• Neonatal observation for signs of infection is intensified with rupture duration beyond 18 to 24 hours

Referral: standard obstetric-led intrapartum care; escalate for any sign of chorioamnionitis or fetal compromise.