- 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.
- 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).
- Literature review and expert commentary.
- Funding: None.
- Based on current literature, recommendations may change.