In the event of severe maternal infection, start antibiotherapy prior to dexamethasone. – For preterm rupture (< 37 weeks LMP), transfer the mother, if possible, to a facility where the preterm neonate can receive intensive care.Īfter 26 weeks LMP and before 34 weeks LMP, help lung maturation with dexamethasone IM: 6 mg every 12 hours for 48 hours. Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, Thornton JG, Crowther CA PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016 Jan 30 387(10017):444-52. Before term: monitor and, if there are no complications, perform induction at 37 weeks LMP. At term: if labour does not start spontaneously, induce labour 12 to 24 hours after rupture of membranes The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. In the event of infection, induce labour immediately (Chapter 7, Section 7.3).After 34 weeks LMP, the risk of infection is greater than the risk of preterm birth: do not administer tocolytics.Before 34 weeks LMP: tocolytic agent, except if there are signs of intra-uterine infection.For the neonate : see Chapter 10, Section 10.1.1 and Section 10.3.3.Presence of infection whether in labour or not, regardless of the duration of the ruptureĬontinue IV administration for 48 hours after fever disappears then, change to amoxicillin + metronidazole PO to complete 7 days of treatment. ![]() No infection and rupture of membranes ≥ 12 hours, whether in labour or notĪmpicillin IV: 2 g, then 1 g every 4 hours during labour until the child is born – Vaginal examinations: as few as possible, always with sterile gloves and only if the woman is in labour or induction of labour is planned.Īmoxicillin PO: 1 g 3 times daily for 7 daysĭo not use amoxicillin/clavulanic acid (increased incidence of necrotizing enterocolitis in neonates).Īmpicillin IV: 2 g, then 1 g every 4 hours during labour until the child is born (whether the patient received amoxicillin PO beforehand)ĭo not continue antibiotics after delivery. – Admit to inpatient department and monitor: temperature, heart rate, blood pressure, uterine contractions, foetal heart tone, abnormal amniotic fluid (foul-smelling, purulent). urinary or genital tract infection) and treat accordingly. – In the event of preterm rupture of membranes, look for a maternal cause (e.g. – Pre-term birth, if the rupture occurs before 37 weeks LMP. ![]() – 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. In case of doubt, perform speculum examination: look for fluid pooling in the vagina or leaking from cervical os when patient coughs.ĭifferential diagnosis: urinary incontinence, expulsion of the mucus plug, leucorrhoea. Discharge of amniotic fluid before the onset of labour, due to a leak or frank rupture of the amniotic sac.
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