Preterm Labor / Premature Rupture of Membranes (PPROM) Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Expectant or immediate delivery
   Gestation and membrane status — expectant or immediate delivery? (Preterm labor (<37 weeks regular contractions + cervical change)/preterm premature rupture of membranes (PPROM). Assess gestation, whether membranes are ruptured, infection (chorioamnionitis), fetal status, any tocolysis contraindications. Goals: gain the corticosteroid window for fetal lung maturity, neuroprotection, transfer to a center with NICU.)
   • Immediate delivery needed (chorioamnionitis/fetal distress/abruption, etc.) → Immediate delivery needed
   • Expectant management (no infection/fetal distress/contraindication) → Expectant · steroids + magnesium + tocolysis
2. [End] Expectant · steroids + magnesium + tocolysis
   Expectant management (about 24–34 weeks, no infection/fetal distress/delivery contraindication): a single course of antenatal corticosteroids for fetal lung maturity (betamethasone/dexamethasone); magnesium sulfate for fetal neuroprotection <32 weeks; short-course tocolysis to gain the 48 h steroid window/transfer (e.g. nifedipine/atosiban, avoid when contraindicated); GBS prophylactic antibiotics; for PPROM add latency-prolonging antibiotics and monitor for infection; transfer to a center with NICU.
3. [End] Immediate delivery needed
   Immediate delivery needed (chorioamnionitis/fetal distress/severe hemorrhage/abruption/severe preeclampsia, etc.): no further tocolysis; broad-spectrum antibiotics if infection suspected, deliver per obstetric indication (vaginal or cesarean); if time permits still give a single steroid course and magnesium sulfate for neuroprotection (<32 weeks); neonatal team present.

Source guidelines & references

• Preterm labor/PPROM (ACOG; WHO antenatal corticosteroid and magnesium sulfate recommendations)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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