Discharge of amniotic fluid before the onset of labour, due to a leak or frank rupture of the amniotic sac.
In case of doubt, perform speculum examination: look for fluid pooling in the vagina or leaking from cervical os when patient coughs.
Differential diagnosis: urinary incontinence, expulsion of the mucus plug, leucorrhoea.
– Intra uterine infection; suspect infection in case of maternal fever associated with one or more of the following signs: persistent foetal tachycardia or foetal death, foul-smelling or purulent amniotic fluid, uterine contractions. Never administer a tocolytic agent, no matter what the gestational age, when intra-uterine infection is suspected.
– Prolapsed cord.
– Pre-term birth, if the rupture occurs before 37 weeks LMP.
– In the event of preterm rupture of membranes, look for a maternal cause (e.g. urinary or genital tract infection) and treat accordingly.
– Admit to inpatient department and monitor: temperature, heart rate, blood pressure, uterine contractions, foetal heart tone, abnormal amniotic fluid (foul-smelling, purulent).
– Vaginal examinations: as few as possible, always with sterile gloves and only if the woman is in labour or induction of labour is planned.
• For the mother:
Preterm (< 37 weeks)
amoxicillin PO: 1 g 3 times daily for 7 days
Preterm (< 37 weeks)
ampicillin IV: 2 g, then 1 g every 4 hours during labour until the child is born (whether the patient received amoxicillin PO beforehand)
Term (≥ 37 weeks)
ampicillin IV: 2 g, then 1 g every 4 hours during labour until the child is born
Presence of infection whether in labour or not, regardless of the duration of the rupture
ampicillin IV: 2 g every 8 hours
– If there are uterine contractions:
• Before 34 weeks LMP: tocolytic agent, except if there are signs of intra-uterine infection.
• After 34 weeks LMP, the risk of infection is greater than the risk of preterm birth: do not administer tocolytics.
– Induction of labour:
• In the event of infection, induce labour immediately (Chapter 7, Section 7.3).
• If there is no infection:
- At term: if labour does not start spontaneously, induce labour 12 to 24 hours after rupture of membranes;
- Before term: monitor and, if there are no complications, perform induction at 37 weeks LMP.12
– For preterm rupture (< 37 weeks LMP), transfer the mother, if possible, to a facility where the preterm neonate can receive intensive care.
– Prepare the foetus for preterm birth:
After 26 weeks LMP and before 34 weeks LMP, help lung maturation with dexamethasone IM: 6 mg every 12 hours for 48 hours. In the event of severe maternal infection, start antibiotherapy prior to dexamethasone.