Management

The management of spontaneous rupture of membranes is divided into measures taken to diagnose the condition, to prolong the pregnancy if before 34 weeks gestation, or to deliver the baby if after this stage.

Diagnosis involves a speculum being passed into the vagina to ascertain whether liquor is leaking. Confirmation is obtained by assessment of the lecithin to sphingomyelin ratio of the fluid or the Nitrazine test.

Measures before 34 weeks include:

• admit the patient
• forbid all but the initial diagnostic examination to minimise the risk of infection
• undertake an ultrasound examination - to assess fetal position and the amount of amniotic fluid - and fetal heart rate monitoring to primarily detect cord compression
• stop premature labour with tocolytic agents to allow time for corticosteroid maturation of the lungs
• undertake elective delivery if there are any signs of infection

Measures after 34 weeks include:

• if labour has not begun spontaneously within 12 hours, labour can be careful induced by dilute oxytocin infusion.
• If this fails, a caesarian section should be carried out. A breech presentation or transverse lie are contraindications to induction.