Starting at: First OB appointment (or even before trying to conceive)
Frequency: Every 2 weeks
Purpose: To check for and treat infection.

Along with cervical weakness, bacterial infection is one of the only identifiable explanations for PROM. Bacterial infection can weaken the membranes to the point of a premature rupture.

Whether or not a bacterial infection caused your PROM, it is important to do routine tests to make sure that bacterial infection does not complicate your PAP pregnancy. Ask your health care practitioner to do wet preps or cultures, not just a dipstick test. A culture is more accurate because the sample is given time to grow or show traces of the infection, compared to a pH or dipstick test which can sometimes give misleading or inaccurate results. Also, a culture can more accurately pinpoint what medication will be effective to treat the infection.

Be aware that the health care community is divided about which bacterial infections require treatment during pregnancy and at what point during the pregnancy, and whether long-term antibiotic use is advisable. If you think you should be treated even though your practitioner does not feel treatment is necessary, do more research and present the information to your practitioner.

Infections to test for and treat as soon as possible include:

• Urinary tract infections (UTIs).
• Bacterial vaginosis (BV) /gardnerella. Some studies show that treatment for BV substantially reduces the incidence of PROM. Other studies say that the link between BV and PROM is inconclusive.
• Yeast infection. It is particularly important that your doctor do a culture and confirm yeast before treating to ensure that you are taking the appropriate medication. 

• Group B Streptococcus (GBS). Usually your practitioner will only test for GBS once you reach 36 weeks, to prevent transmission to your baby via vaginal delivery. However, you may want to be tested routinely from the beginning of your pregnancy because it is not known what role GBS plays in PROM. Your practitioner will almost certainly treat GBS if it is present in your urine; discuss whether to treat if it is only present in your vaginal flora.
• Citrobacter freundii. Members of the PROM list have reported that this is treatable with gentamicin-family antibiotics.

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