Antibiotics for prelabour rupture of membranes at or near term
RHL practical aspects by Gülmezoglu AM
FIRST CONTACT (PRIMARY CARE) LEVEL
- The diagnosis of membrane rupture should be confirmed by observing the flow of amniotic fluid either at the perineum or through a sterile speculum examination.
- If the presentation is not cephalic, careful vaginal examination with fingers should be performed to exclude cord prolapse.
- If the woman is not in active labour within 12–24 hours, it may be advisable to transfer the woman to a secondary level health-care facility.
- There is no evidence to recommend the use or non-use of antibiotics before delivery. If the labour onset is delayed it may be advisable to administer broad-spectrum antibiotic coverage.
- Vaginal examinations should be minimized to reduce the risk of introducing infection.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
- In addition to the procedures at the primary care level, the Group B Streptococcus status should be determined (if facilities available) and appropriate antibiotic treatment initiated if the woman is found to be positive.
- If the membrane rupture cannot be confirmed, the fetal heart rate reassuring and there is sufficient amniotic fluid in utero by ultrasound then the woman can be sent home with careful pad checks to verify or monitor any possible amniotic fluid leakage.
- If the prelabour rupture of membranes has exceeded 24 hours it may be prudent to start antibiotic treatment with broad coverage.
AT HOME OR IN THE COMMUNITY
- Women should be informed about the possible rupture of membranes and told to go to a health centre if they suspect more than normal discharge or clear fluid drainage.
This document should be cited as: Gülmezoglu AM. Antibiotics for prelabour rupture of membranes at or near term: RHL practical aspects (last revised: 8 June 2009). The WHO Reproductive Health Library; Geneva: World Health Organization.