Royal College of Obstetricians and Gynecologists guidelines: PPROM after 24 weeks

  • Thomson AJ
  • BJOG
  • 17 Jun 2019

  • International Clinical Digest
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Takeaway

  • The Royal College of Obstetricians and Gynecologists has released guidelines for the management of preterm prelabor rupture of membranes (PPROM) after 24 weeks of gestation.

Why this matters

  • PPROM complicates 3% of pregnancies and is responsible for 30%-40% of preterm births.

Key recommendations

  • The diagnosis of PPROM should be made by maternal history and sterile speculum exam.
  • If speculum exam diagnosis is not possible, diagnostic tests (insulin-like growth factor-binding protein 1 or placental alpha-microglobulin-1) can be used.
  • Antibiotic prophylaxis should be given for 10 days in the absence of labor; these guidelines recommend erythromycin.
  • Women should be offered corticosteroids up to 35 weeks 6 days.
  • Chorioamnionitis is diagnosed through a combination of clinical assessment, maternal blood tests, and fetal heart rate.
  • Women should be offered expectant management up to 37 weeks 0 days.
  • If delivery is expected because of spontaneous labor or planned induction, 24 hours of intravenous magnesium sulfate should be offered between 24 weeks 0 days and 29 weeks 6 days.
  • Women with a history of PPROM are at risk for recurrent PPROM, with OR of 8.7 (95% CI, 6.7-11.4).

Study design

  • Literature review and expert commentary.
  • Funding: None.

Limitations

  • Based on current literature, recommendations may change.