Preterm Labour (PTL) and Preterm Prelabour Rupture of Membranes (PPROM)

Description

General measures

Medicine treatment

Referral

---

O60.0/O42.0-2/O42.9

DESCRIPTION

Preterm: < 37 weeks' gestation.
Most problems occur at < 34 weeks’ gestation.
Confirm ruptured membranes by sterile vaginal speculum.
Preterm labour confirmed by regular uterine contractions with progressive cervical changes.

GENERAL MEASURES

Assess foetal wellbeing.
Estimate foetal weight.
Deliver if chorio-amnionitis suspected.

MEDICINE TREATMENT

If gestation <34 weeks:

Pre-hydrate before administration of nifedipine:

• Sodium chloride 0.9%, IV, 200 mL.

AND

• Nifedipine, oral, 20 mg.
  • If contractions persist, follow with 10 mg after 30 minutes then 10 mg 4 hourly for up to 48 hours.

If gestation <32 weeks and where nifedipine contra-indicated:

• Indomethacin, oral, 50 mg immediately then 25 mg 4 hourly for up to 48 hours.

LoE:Ia^xxx

---

Note:

Indomethacin may cause oligohydramnios, and its use is associated with a risk of premature closure of the ductus arteriosus. Use only if there is intolerance to nifedipine.

---

To improve foetal lung maturity at 26–34 weeks: (Z29.2)

• Betamethasone, IM, 12 mg, 2 doses 24 hours apart.

LoE:Ia^xxxi

If betamethasone is not available:

• Dexamethasone, IM, 8 mg, 3 doses 8 hours apart.

LoE:Ia^xxxii

---

Note:

Corticosteroids are maximally effective about 24 hours after administration of the first dose. Therefore, give as soon as possible following diagnosis of PTL or PPROM.

---

Antibiotic therapy (Z29.2)

• Ampicillin, IV, 1 g 6 hourly for 48 hours.

Follow with:

• Amoxicillin, oral, 500 mg 8 hourly for a further 5 days.

AND

• Azithromycin 1g orally as a single dose.

LoE:IIIa^xxxiii

Severe penicillin allergy: (Z88.0)

• Clindamycin, IV, 600 mg 8 hourly for 48 hours.

Follow with:

• Clindamycin, oral, 450 mg 8 hourly for a further 5 days.

AND

• Azithromycin 1g orally as a single dose.

LoE:IIIa^xxxiv

Prepare for appropriate care of preterm infant.

REFERRAL

• Foetus that may require neonatal intensive care, e.g. estimated weight <1.5 kg or gestation <32 weeks.
• Foetus requiring specialised treatment after birth, e.g. surgery.
• Severely ill mother.

Click here to access the pdf.

Click here to access the Interruption in the Supply of Betamethasone Disodium Phosphate Circular.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2025-9 Review_Version 2.0_26 March 2026

Chapter 6 Obstetrics_6.11.1 Preterm Labour (PTL) and Preterm Prelabour Rupture of Membranes (PPROM)