Preterm premature rupture of the membranes

The management of a patient with preterm premature rupture of the membranes - in the absence of evidence of chorioamnionitis - generally involves a conservative period in order to administer corticosteroids and prolong gestation.

Delivery is indicated if there is clinical evidence of infection or a rise in serum markers. Following publication of the ORACLE study (Kenyon, 2001), many clinicians prescribe a course of erythromycin in this situation in order to prolong gestation and reduce neonatal infectious morbidity.

	If GBS is detected on a vaginal swab, antenatal treatment specifically for GBS is not necessary prior to labour. Intrapartum prophylaxis should be considered, especially if labour occurs before 37 weeks.

There is currently no evidence to indicate labour should be induced earlier for patients with preterm rupture of the membranes who are found to be GBS carriers and decisions should be based upon usual criteria.