Antibiotics for preterm rupture of membranes
RHL practical aspects by Festin M
FIRST CONTACT (PRIMARY CARE LEVEL)
1. Women should be informed that any watery leakage from the vagina, with or without associated uterine contractions, should be a reason to consult their doctor or health care professional immediately.
2. The proper diagnosis of preterm prelabour rupture of the membranes (pPROM) should be standardized and simplified (such as visual inspection with a sterile speculum and vaginal pH testing), for easy access to the patients and the peripheral health workers.
3. Once the proper diagnosis is made, provisions to start parenteral antibiotics should be made, particularly if delivery is not expected soon. The antibiotic of choice is erythromycin which may be given intravenously or orally at this level of care.
4. Antenatal corticosteroids should be administered.
5. Since facilities for intensive neonatal care will not available at this level, transfer to centres with such facility should be made immediately.
6. An awareness of associated complications such as cord prolapse should make the first contact health providers be vigilant for immediate transfer to a hospital setting, where delivery and neonatal care facilities will be available.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
1. The diagnosis made at the primary care level should be confirmed in order to avoid any unnecessary next steps in patient management.
2. The choice, dose, route and duration of antibiotic treatment should be based on the common organisms found in cultures from the genital tract of pregnant women in the country.
3. If this information is not available, a broad spectrum antibiotic, preferably a macrolide such as Erythromycin, which is relatively safe for pregnant women, should be administered intravenously until the patient delivers; if delivery does not take place within the next few days the antibiotic should be continued for at least one week.
4. If intravenous antibiotics are to be given it may be useful to leave the intravenous line in place.
5. The newborns of women with pPROM will in all likelihood need intensive care. Adequate intensive care and critical care personnel and facilities should be available and ready to deal with such cases.
AT HOME OR IN THE COMMUNITY
If watery leakage from the vagina is detected at any time, immediate consultation with a physician or a health care professional is necessary.
This document should be cited as: Festin M. Antibiotics for preterm rupture of membranes: RHL practical aspects (last revised: 14 June 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.