Care of Women With Preterm Prelabour Rupture of the Membranes Prior to 24+0 Weeks of Gestation: Scientific Impact Paper No. 76.

Rupture of the membranes is commonly referred to as 'waters breaking'. This usually occurs just before or during labour. In around three in 100 pregnancies it occurs before 37⁺⁰ weeks of pregnancy (preterm), but the woman does not go into labour within 24 h: this is called preterm prelabour rupture of the membranes (PPROM). These women often give birth preterm. This paper looks at PPROM before 24⁺⁰ weeks of pregnancy. This happens in a much smaller number of women. PPROM prior to 24⁺⁰ weeks of pregnancy is particularly concerning because of the chance of the baby being born extremely preterm. It is considered in the best interest of the baby not to offer resuscitation and intensive care if they are born before 22⁺⁰ weeks, meaning that these babies do not survive. Babies born between 22⁺⁰ and 26⁺⁰ weeks are at risk of severe and sometimes life-long problems. They also have a lower chance of survival than babies born later. Women sometimes develop an infection after PPROM, which can be extremely dangerous. If this happens, doctors will discuss ending the pregnancy even if the baby is very unlikely survive so that the woman does not become unwell (termination for a medical reason). However, some babies do survive and are discharged home, well, and most mothers have no long-term physical problems. This situation is very difficult for women who are pregnant, as well as their partners and wider families. It is made more difficult by a lack of clear information for doctors and midwives about how well women and babies in this situation will do, and how to look after them. This can result in lots of variation in information and care for women. Here we summarise the current evidence about this condition. Firstly, we explain available information on how well women and babies are likely to do. Then we discuss evidence about predicting the problems individual women and babies might have. Finally, we look at evidence on the ways in which healthcare professionals can care for women and their babies up to birth.