Early PPROM: women and babies who should not be lost in the system

Abstract

There are no national or international agreements about how to manage women with early preterm prelabour rupture of membranes, and services are inadequately organised for their needs, write Laura Goodfellow, Ciara Curran, and Angharad Care Maternity services in the UK are rightly under public scrutiny. Mothers in the UK are about three times more likely to die within 42 days of pregnancy than women in Denmark and Norway.1 But there are national drives to improve equity and quality of care, support the workforce, and listen to patients.234 Most cases of the preterm prelabour rupture of membranes (PPROM) occurring after 24 weeks of pregnancy have a good outlook, with care underpinned by national guidelines.5 But for the one in 1000 women who experience early PPROM between 16 and 23 weeks’ gestation, the current initiatives to improve pregnancy outcomes are likely to be inadequate. These women often fall through the cracks between emergency departments and midwifery, gynaecology, obstetrics, and neonatology services, and are left unsupported because healthcare staff lack guidance about how or where to manage their care. Conflicting information adds to psychological distress for women and families facing early PPROM.6 Very little evidence exists about the optimal management of early PPROM from which to formulate guidelines.5 In early PPROM, the protective membranes surrounding the baby rupture, resulting in leaking amniotic fluid before the onset of labour. …