• Sterile speculum exam preferable to digital exams to avoid increasing risk of chorioamnionitis
  • Chorioamnionitis is a contraindication to significant prolongation of pregnancy (other than tocolysis to accomplish transfer of patient). Maternal exam/uterine tenderness, vital signs, FHR, CBC, C reactive protein all useful in assessing for that condition
  • Use as many tools as needed to assure diagnosis of PPROM (SSE for nitrazine/ferning/pooling plus Amnisure if others are not conclusive)
  • Betamethasone for 24.0-32.0 weeks. Benefit not well proven for 32.0-34.0 weeks, however, it is still common practice to use in that situation (we do at MSJH)
  • Broad spectrum antibiotics with Ampicillin/Erythromycin (or Ampicillin/Azithromax) for 1 week shown to prolong latency period, so consider starting those (see order sheet for details). This protocol covers GBS. See PPROM Antibiotics order set.
  • Ultrasound for fetal position particularly important in these patients


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