Term PROM (>=37 weeks)
Clinical detail
Additional detail checked 2026-10-17 against the linked sources. This check covers the section below; the rest of the module retains its displayed verification status.
At term, confirm membrane rupture and separate uncomplicated waiting from infection, fetal concerns or GBS-related risks.
Assessment & interpretation
- Record when fluid loss began, its appearance, maternal symptoms and fetal movements.
Decisions that change management
- NICE offers induction promptly or expectant care for up to approximately 24 hours. If labour has not begun after that period, offer induction.
- A positive GBS test in the current pregnancy changes the immediate birth and antibiotic discussion.
Follow-up & safety-netting
- Explain symptoms requiring immediate reassessment and document the agreed return time.
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Admit labour or an indication for induction/monitoring, maternal/fetal concern, bleeding, abnormal fluid or suspected infection. GBS-related circumstances may favour immediate birth planning.
When clinic, day care or home care may be suitable
- After assessment, discuss induction now or expectant management for up to about 24 hours when appropriate; take infection risk, GBS history/status and maternal/fetal wellbeing into account.
Before going home
- Mother and fetal assessment are reassuring, no condition requires inpatient care and the planned induction/review time is booked.
- After birth, review the newborn observation requirements after prolonged rupture; maternal discharge criteria do not substitute for newborn assessment.
Discharge medicines and treatment changes
- No blanket home antibiotic course for every uncomplicated term PROM. Document indicated intrapartum antibiotics and the remaining treatment only if infection is actually diagnosed.
Tests, pending results and their reviewer
- Record the rupture time, GBS history/status and maternal/fetal assessments; communicate duration of rupture to the neonatal team.
Home care and counselling
- NICE: during expectant care check temperature every 4 hours while awake and report changes in discharge colour/smell or movements. Give a clear return plan.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
About 24 hours from membrane rupture if labour has not started | Offer induction under the selected NICE pathway; record the actual appointment and whom to call sooner. |
After birth | Complete the relevant maternal and newborn observations and follow-up. |
Return urgently
- Fever, feeling unwell, offensive/discoloured fluid, bleeding, reduced movements or labour symptoms requires immediate maternity contact.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
Outpatient-safe only if fully assessed, low-risk, GBS-negative, clear return instructions.
③ First-line treatment & drug regimens
- Offer INDUCTION OF LABOUR generally within 24 h (NICE NG235 framework) - reduces infection without raising caesarean rates
- OR wait up to 24 h if woman prefers + all reassuring (advise avoiding intercourse; report fever/reduced movements)
- GBS colonisation/known carrier: prompt birth plan plus intrapartum prophylaxis using the complete benzylpenicillin card (3 g loading, then 1.5 g every 4 h until birth). Severe allergy needs a separately prescribed, susceptibility-appropriate alternative.
- Intrapartum GBS prophylaxis when indicated, distinct from treatment of maternal sepsis
- Do not confuse grams, milligrams and million units; ampicillin is a different regimen with 2 g loading then 1 g every 4 h.
- Allergy/anaphylaxis, renal function and timing of each dose; reassess fever/chorioamnionitis for a treatment combination
Definitive treatment
Labour onset/birth.
Monitoring
| Waiting option | Schedule |
|---|---|
Maternal temp/pulse | 4-hourly self-report + clinic checks |
Liquor colour | Report meconium/foul immediately |
FM counts | Daily awareness |
Treatment failure
- Fever/tachycardia -> chorioamnionitis workup + antibiotics + birth
Escalation
- Neonatal observation plan at birth per GBS risk factors
⑮ Complications & their management
Chorioamnionitis
Antibiotics + expedited birth
Early-onset neonatal GBS
Risk-based neonatal observation per GTG36
Post-treatment care
- Standard fourth-stage care
- Document GBS pathway followed
Diagnosis & assessment
- Cord prolapse on presentation
- Meconium/foul liquor
- Fever
- Reduced movements/abnormal CTG
Definition: Membrane rupture at term before labour onset.
Initial assessment
- Speculum confirmation if history unclear; nitrazine/ferning or IGFBP1 adjuncts
- CTG 20-30 min; presentation check
- GBS screening status (rectovaginal swab if not done within 5 wks)
- Temp/pulse baseline
Investigations
| Test | Looking for |
|---|---|
CTG + presentation | Immediate reassurance |
GBS status | Antibiotic pathway trigger |
Principles & follow-up
Management principles
Sources (11)
2023-09-29 · updated 2026-06-09 · checked 2026-08-23 · verified-live
Open source ↗
NICE overview + Update information page (dates above confirmed)
2017-09 · checked 2026-08-23 · verified-summary
Open source ↗
RCOG listing confirms 3rd edition current + replacement in development (quarterly update page)
04 November 2021 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for iol, prom-term. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge c…
· checked 2026-10-17 · verified-live
Open source ↗
GBS maternal IV loading 3 g (5 million units) then 1.5 g (2.5 million units) every four hours until birth; >1.2 g administration at least one minute/300 mg. Section 6.6: each 1.2 g vial in at least 8 mL for injection or 20 mL for infusion; ~0.8 mL powder displacement.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary PDF downloaded; term prelabour rupture, selected expectant care and induction around 24 hours, temperature/return precautions, maternal post-birth assessment and newborn observation after prolonged membrane rupture checked. This is scoped to the implemented admission/transfer recommenda…
· checked 2026-10-17 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for gbs. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. The page explicitly says its related guidel…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.