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Nursing QUESTION #9147
Question 1
A woman at 24 weeks gestation is diagnosed with preterm premature rupture of membranes (PPROM). Which combination of interventions is MOST evidence-based?
  • Immediate induction of labor to prevent infection
  • Hospitalization + antibiotics (erythromycin) + antenatal corticosteroids + nifedipine tocolysis✔️
  • Oral antibiotics at home with weekly follow-up
  • Cerclage placement and progesterone supplementation only
Correct Answer Explanation

PPROM = Rupture of membranes before 37 weeks gestation without labor.

Evidence-based management bundle (ACOG/RCOG):

InterventionRationaleDrug/Dose
HospitalizationMonitor for chorioamnionitis, cord prolapse—
AntibioticsProlong latency period, reduce chorioamnionitisErythromycin 250 mg QID × 10 days (avoid amoxicillin-clavulanate — associated with NEC)
Antenatal corticosteroidsFetal lung maturity (if 24–34 weeks)Betamethasone 12 mg IM × 2 doses, 24 hr apart
MgSO₄ neuroprotectionIf <32 weeks, reduces cerebral palsy\(4\,\text{g}\) IV loading dose
GBS prophylaxisIf GBS status unknownPenicillin G IV

Tocolysis: Short-term tocolysis (48 hr) to allow steroids to act, but not for prolonged tocolysis as it may mask infection signs. Nifedipine or indomethacin used.

Chorioamnionitis signs (mandate delivery regardless of GA): fever, uterine tenderness, fetal tachycardia, maternal tachycardia, foul-smelling liquor, elevated CRP/WBC.