Treatment
In case of PROM at term,
Delivery should be done within 24 hours,
Assess cervical status and induce labour accordingly with misoprostol (PO) 25mcg 8hourly (Max 3doses) in unfavorable cervix. Give oxytocin (IV) 5 IU in 500ml of D5% for a favourable cervix.
With right indications perform caesarean section.
In case of PPROM,
If no sign of infection, wait for foetal maturity and give
dexamethasone (IM) 6mg 12hourly for 48 hours if pregnancy is less than 34 weeks for fetal lung maturation.
AND
nifedipine (PO) 20mg 8hourly for 7 days for tocolysis
Administer prophylactic antibiotics
metronidazole (PO) 400mg 8hourly 10days.
AND
amoxicillin + clavulanic acid (FDC) (PO) 625mg 8hourly for 10days
In case of infection(pyrexia, foul smelling liquor), Delivery must be done irrespective of gestation age. Give IV antibiotics: metronidazole (IV) 500mg 8hourly for 5-7 days
AND
amoxycillin + clavulanic acid (FDC) (IV) 1.2g 8hourly for 5-7days
OR
ceftriaxone + sulbactam (FDC) (IV) 1.5g 12hourly for 5-7 days