Spontaneous rupture of the membranes at or beyond 37 completed weeks gestation and prior to the onset of labour.
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Management
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Birth suite
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Admit to the birth suite.
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Diagnosis
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- Routine antenatal admission in labour ward
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- Perform cardiotocograph (CTG)
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- The diagnosis can usually be made on clinical grounds by a combination of history and identification of amniotic fluid in the vagina on sterile speculum examination. All women presenting with a history suspicious of PROM must have a sterile speculum examination.
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- All non-cephalic presentations presenting with ruptured membranes at term must have a digital vaginal examination to exclude cord prolapse
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- Ultrasound examination showing markedly reduced liquor volume in the presence of normal kidneys and the absence of IUGR is highly suggestive of ruptured membranes, however normal liquor volume does not exclude the diagnosis
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Subsequent management
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- If there is no liquor visible, the patient can be discharged from hospital unless there is strong clinical suspicion of the diagnosis. If the diagnosis is in doubt, the patient may be admitted for pad checks.
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Induction of labour
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Timing
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1. Women who are GBS positive or have meconium-stained liquor should have labour induced promptly upon presentation, if the CTG is satisfactory. Appropriate intrapartum chemoprophylaxis should be used for women who are GBS positive - Refer CPG Strategies to prevent early onset GBS sepsis in neonates
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GBS negative women with PROM >24 hours will be commenced on antibiotics only if indicated (eg. temperature >38°C).
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2. Other women should have labour induced within 24 hours from the time of ROM.
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Method
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1. CTG
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2. Forewater rupture must be confirmed prior to induction of labour by vaginal examination. Baseline cervical assessment. If the forewaters are intact, forewater amniotomy should be performed.
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3. Labour should be induced using an intravenous infusion of oxytocin.
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4. During induced labour, continuous electronic fetal monitoring should be performed.
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5. Antibiotics should be commenced as per GBS protocol.
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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