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

Preterm labour (PTL)

Preterm prelabour rupture of membranes (PPROM)

Prelabour rupture of membranes at term (PROM)

---

PRETERM LABOUR (PTL)

O60.0
DESCRIPTION

Regular painful contractions: 3 per 10 minutes, occurring < 37 weeks of gestation.

---

Note: 
Women with a previous spontaneous preterm delivery are at higher risk for preterm delivery in the next pregnancy. Refer the following high-risk cases for cervical screening:

•  A history of 2^nd trimester miscarriage (between 16 and 26 weeks).
•  Previous history of spontaneous preterm birth between 27 and 34 weeks.
•  No need to refer previous late preterm deliveries (34-37 weeks).
LoE:IVb²⁹

---

GENERAL MEASURES

<26 weeks:

• Refer without tocolysis (medicines to inhibit uterine contractions).

LoE:IVb³⁰

26–34 weeks of gestation:

• Refer with initial tocolysis and corticosteroids.

˃34 weeks of gestation:

• Allow labour to continue at midwife obstetric unit.

MEDICINE TREATMENT

To improve foetal lung maturity at 26–34 weeks:

Z29.2

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

LoE:Ia³¹

Tocolysis:

Z29.2

Preload with:

• Sodium chloride 0.9%, IV, 200 mL.

THEN

• Nifedipine, oral, 20 mg as a single dose.
  • Follow with 10 mg after 30 minutes, if contractions persist.
  • Then 10 mg every 4 hours until patient is transferred.
  • Maximum duration: 24 hours.

REFERRAL

All cases before 34 weeks.

---

PRETERM PRELABOUR RUPTURE OF MEMBRANES (PPROM)

O42.0-1/O42.9

DESCRIPTION

Rupture of the membranes before 37 weeks' gestation.
Confirmed with a sterile speculum examination demonstrating leakage of amniotic fluid.
If there is clinical uncertainty test for pH – liquor is alkaline.
Avoid digital vaginal examination.

MEDICINE TREATMENT

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

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

LoE:Ia³²

Initiate 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 1 g orally as a single dose.

LoE:IIa³³

Severe penicillin allergy: (Z88.0)

• Azithromycin 1 g orally as a single dose and refer urgently.

REFERRAL

All cases, but refer urgently if PPROM < 34 weeks or cases of severe penicillin allergy.

---

PRELABOUR RUPTURE OF MEMBRANES AT TERM (PROM)

O42.0-1/O42.9

DESCRIPTION

Rupture of membranes before the onset of labour at term (>37 weeks).
A sterile speculum examination is required to visually confirm amniotic fluid draining through the cervical os.

GENERAL MEASURES

• If PROM is followed by uterine contractions at >34 weeks' gestation, allow labour to proceed.
• If the woman does not develop uterine contractions within 12 hours of PROM, commence antibiotics and transfer for induction of labour.

MEDICINE TREATMENT

Prolonged pre-labour rupture of membranes >12 hours/ suspected chorio-amnionitis:

Initiate antibiotic therapy and refer urgently: 

O41.1

• Ampicillin, IV, 1 g as a single dose.

AND

• Metronidazole, oral, 400 mg as a single dose and refer.

Severe penicillin allergy:

Z88.0

• Azithromycin, oral, 500 mg as a single dose.

AND

• Metronidazole, oral, 400 mg as a single dose and refer.

LoE:IIa³⁴

REFERRAL

Urgent

• Suspected chorio-amnionitis (refer after starting antibiotics)
• Prolonged pre-labour rupture of membranes (>12 hours)
• Meconium stained liquor

Click here to access the pdf.

---

Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026

Chapter 6: Obstetrics and Gynaecology_6.4.7 Preterm Labour (PTL) and Preterm Prelabour Rupture of Membranes (PPROM)