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Preterm prelabour rupture of membranes — MCCQE Part 1 MCQ

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ModeratePregnancyPreterm prelabour rupture of membranesMCCQE Part 1

27-year-old woman at 32 weeks' gestation presents with a gush of clear fluid. Pooling is seen on speculum examination; she is afebrile and contractions are absent. Which of the following is the most appropriate next step?

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Correct answer: A — Admit for PPROM management with steroids, antibiotics and fetal/maternal monitoring

Admit for PPROM management with steroids, antibiotics and fetal/maternal monitoring is best because PPROM before term requires latency antibiotics, steroids and surveillance. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Digital examinations are avoided unless delivery is imminent.

Reference: SOGC PPROM guidance