Term prelabour rupture of membranes

It is 06:15 and a well 39-week primigravida walks into the birth suite with wet leggings and no contractions. Nothing about her needs an emergency. Everything about her needs a decision, and the decision has a clock attached to it: from the moment those membranes went, the risk of infection has been climbing while the chance of spontaneous labour has been ticking down.^[1][4]

Overview and definition

Term prelabour rupture of membranes is spontaneous rupture of the membranes at or after 37+0 weeks, before labour begins. Two other definitions travel with it and examiners like them separated: ^[6][4]

• Prolonged rupture of membranes — commonly defined at 18 or 24 hours, and used as a risk factor in neonatal sepsis assessment rather than as a management trigger in its own right.^[9][6]
• Suspected Triple I — the NICHD replacement for intrapartum "chorioamnionitis": a documented fever without a clear source plus at least one of fetal tachycardia over 160 bpm for 10 minutes or longer, a maternal white cell count over 15 000 per cubic millimetre in the absence of corticosteroids, or definite purulent fluid from the cervical os.^[7]

The two management strategies are planned early birth (induction immediately or within about 24 hours) and expectant management (no planned intervention within 24 hours, with surveillance). Everything else in this topic is a variation on choosing between them.^[2]

^{[1] [2] [12]}

References14ShowHide

1. [1]Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term N Engl J Med, 1996.PMID 8598837
2. [2]Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more) Cochrane Database Syst Rev, 2017.PMID 28050900
3. [3]Hannah ME, Ohlsson A, Wang EE, Matlow A, Foster GA, et al. Maternal colonization with group B Streptococcus and prelabor rupture of membranes at term: the role of induction of labor Am J Obstet Gynecol, 1997.PMID 9369819
4. [4]Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term Am J Obstet Gynecol, 1997.PMID 9396886
5. [5]Hodnett ED, Hannah ME, Weston JA, Ohlsson A, Myhr TL, et al. Women's evaluations of induction of labor versus expectant management for prelabor rupture of the membranes at term Birth, 1997.PMID 9460311
6. [6]American College of Obstetricians and Gynecologists Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217 Obstet Gynecol, 2020.PMID 32080050
7. [7]Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, et al. Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop Obstet Gynecol, 2016.PMID 26855098
8. [8]American College of Obstetricians and Gynecologists Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797 Obstet Gynecol, 2020.PMID 31977795
9. [9]Verani JR, McGee L, Schrag SJ Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010 MMWR Recomm Rep, 2010.PMID 21088663
10. [10]Chen JC, Jenkins-Marsh S, Flenady V, Ireland S, May M, et al. Early-onset group B streptococcal disease in a risk factor-based prevention setting: A 15-year population-based study Aust N Z J Obstet Gynaecol, 2019.PMID 30203834
11. [11]Hasperhoven GF, Al-Nasiry S, Bekker V, Villamor E, Kramer B Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis BJOG, 2020.PMID 31913562
12. [12]Ram S, Lavie M, Bitan R, Sabag DN, Madar D, et al. Time from pre-labor rupture of membrane at term to delivery in grand multiparous women Int J Gynaecol Obstet, 2026.PMID 41822972
13. [13]Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, et al. 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.PMID 26564381
14. [14]Thomson AJ Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24(+0) Weeks of Gestation: Green-top Guideline No. 73 BJOG, 2019.PMID 31207667