Overview
The Centers for Disease Control and Prevention (CDC) developed an algorithm for managing a woman with preterm premature rupture of the membranes (PROM).
Preterm PROM: less than 37 weeks and 0 days gestation
If the woman's Group B Streptococcus (GBS) status is unknown then a vaginal-rectal swab should be collected for GBS culture.
Issues:
(1) Is the woman in labor?
(2) Is the woman a candidate for GBS prophylaxis? (i.e., either positive GBS screen or unknown GBS status)
(3) Is a goal to prolong the latency for the pregnancy?
If the woman is a candidate for both GBS prophylaxis and prolonging the latency, then it is desirable to select an antibiotic that can serve both functions. If the woman is not allergic to penicillins, then ampicillin can be given 2 g IV initially then 1 g IV q6h for at least 48 hours. Otherwise separate antibiotics may be needed to cover both needs.
GBS prophylaxis started because the GBS status was unknown can be discontinued if the admission culture comes back negative. If the woman is not in labor then GBS prophylaxis is given for 48 hours.
The results of a negative GBS screen are considered valid for 5 weeks. A woman with a negative GBS screen in the 5 weeks prior to presentation does not require GBS prophylaxis.
If the woman is receiving antibiotics to prolong latency then these are continued according to standard protocol.
