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11.4 Premature Rupture of Membranes (PROM)

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It is the rupture of membranes (breakage of the amniotic sac) before the onset of labor. If rupture occurs before 37 weeks it is called preterm premature rupture of membranes (PPROM). Prolonged PROM is a case of premature rupture of membranes in which more than 24 hours have passed between the rupture and the onset of labour. Prolonged PROM for more than twelve hours is a risk of ascending infection which can lead to chorioamnionitis (infection of chorion, amnion and amniotic fluid.

Diagnostic Criteria:

Leakage of watery fluid per vagina confirmed by performing a sterile speculum examination.


  • Ultrasound for fetal wellbeing, amount of liquor and gestation age.
  • Perform culture (e.g. possibility of UTI, STI etc.)

General Management

If PROM at term: Delivery within 24 hours

Pharmacological Treatment

A: (IV) fluids Ringer’s Lactate OR Normal Saline

For PPROM: If no sign of infection, wait for foetal maturity and give  

A: Amoxicillin (PO) 500mg 6 hourly for 10 days  OR

A: Erythromycin (PO) 500mg 6 hourly for 10 days.

If there are signs of infections-pyrexia, foul smelling liquor (chorioamnionitis)

A: Ampicillin 1g (IV) start then 500mg 6hourly for 5–7 days  OR 

A: Ceftriaxone 1g (IV) once for 5 days  OR 

A: Benzyl Penicillin (IV) 2MU every 6 hourly for 5 days


A: Metronidazole 500mg 8 hourly for 5 days

For urgent Delivery Irrespective of Gestational Age 

A: Benzyl penicillin (IV) 2MU 6 hourly


B: Chloramphenicol (IV) 500 mg 6 hourly until the patient is able to take oral medication.

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