17.6.1 When should you conduct the delivery before referral?
Under certain conditions, it is safer for you to conduct the delivery of a woman with PROM where she is (at her home or your Health Post) before referral.
Can you explain why not?
It greatly increases the risk of infection getting into the uterus.
You should support her through the labour before referral if she is:
Don’t do an internal vaginal examination, even wearing surgical gloves, in a woman with PROM!
- already in established labour (yes to Question 1 above)
- and she came to you with a history of term PROM, after 37 completed weeks of gestation and the leakage of fluid happened before the onset of labour (Question 2)
- and you see no evidence of infection (no to Question 4).
If the labour and delivery was normal and the woman and baby are doing well, check them for the next 24 hours. Tell the family to call you and take her to a health facility immediately if there is any sign of infection in the mother or the newborn.
If the woman comes to you with PROM and she is already in established labour which has progressed a long way (late active first stage, or second stage when the woman is wanting to push), even with evidence of infection, or a preterm labour, or you think the fetus may be dead, it is still preferable to conduct the delivery where the woman is and refer her to a health facility as soon as the baby is born.