Diagnosing preterm prelabour rupture of membranes (P‑PROM)

Question 1

In a woman reporting symptoms suggestive of P-PROM, offer a speculum examination to look for pooling of amniotic fluid

Answer 1

• if pooling of amniotic fluid is observed, do not perform any diagnostic test but offer care consistent with the woman having P‑PROM
• if pooling of amniotic fluid is not observed, consider performing an insulin‑like growth factor binding protein‑1 test or placental alpha‑microglobulin‑1 test of vaginal fluid.

Question 2

If the results of the insulin‑like growth factor binding protein‑1 or placental alpha‑microglobulin‑1 test are positive

Answer 2

• Offer care consistent with the woman having P‑PROM
  or
• Re-evaluate the woman’s diagnostic status at a later time point.
• Consider the clinical picture as a whole rather than just the test

Question 3

If the results of the insulin-like growth factor binding protein‑1 or placental alpha‑microglobulin‑1 test are negative and no amniotic fluid is observed:

Answer 3

• do not offer antenatal prophylactic antibiotics
• Explain to the woman that it is unlikely that she has P‑PROM but that she should return if she has any further symptoms suggestive of P‑PROM or preterm labour.

Question 4

In the investigation of P-PROM do not

Answer 4

• Use nitrazine to diagnose P‑PROM.
• Do not perform diagnostic tests for P‑PROM if labour becomes established in a woman reporting symptoms suggestive of P‑PROM