Preterm Labour & Rupture of Membranes
Assess threatened early birth and membrane rupture while recognising infection and fetal risk.
Quick revision ↓ Medical Dictionary
01Recognising preterm labour
Labour before 37 completed weeks is preterm. Contractions alone do not prove established labour, so assess symptoms, gestation, cervical findings and maternal-fetal condition using the appropriate pathway. Consider bleeding, infection and urinary symptoms. Accurate assessment helps avoid both missed early birth and unnecessary intervention when symptoms have another explanation.
02Membrane rupture
Ask about a gush or persistent watery leakage, its timing and associated symptoms. A sterile speculum examination and appropriate tests can help when rupture is uncertain. Avoid unnecessary repeated digital examinations, particularly before labour, because they can increase infection risk. Document fluid appearance and assess fetal presentation, wellbeing and possible cord complications.
03Infection and deterioration
Fever, maternal tachycardia, uterine tenderness, offensive fluid or fetal concerns require prompt review for infection and other complications. No single marker safely rules out intrauterine infection in isolation. Maternal sepsis or fetal compromise may change the balance towards delivery rather than prolonging pregnancy. Escalate deterioration immediately through the local maternity emergency pathway.
04Time-sensitive treatments
Antenatal corticosteroids, selected tocolysis and magnesium for fetal neuroprotection have specific gestational and clinical indications. They are not interchangeable, and contraindications such as infection or bleeding can affect decisions. Follow the current local protocol and senior advice. The aim of delaying selected births is to gain a useful window for fetal benefit or transfer.
05Place of birth and counselling
When early birth is likely, involve neonatal staff and arrange an appropriate level of care if safe. Discuss gestation-specific uncertainty, treatment options and family priorities sensitively. Membrane rupture requires an explicit monitoring and follow-up plan, including infection warning signs. Decisions about antibiotics and delivery timing depend on gestation and the overall clinical situation.
High-Yield Revision
- Contractions alone do not establish preterm labour.
- Ruptured membranes require infection and fetal assessment.
- Steroids, tocolysis and neuroprotection serve different purposes.
Common Pitfalls
- Repeated unnecessary digital examinations after membrane rupture.
- Delaying indicated delivery solely to finish a treatment course.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.