Management of Preterm Premature Rupture of Membranes

1. Women with PPROM should be hospitalized until delivery. Expeditious delivery is indicated for abruptio placentae, intrauterine infection, or evidence of fetal compromise (eg, repetitive FHR decelerations or an unstable fetal presentation that poses a risk of cord prolapse). Pregnancies >32 weeks of gestation with documented fetal lung maturity will achieve better outcomes with immediate delivery than with expectant management.

2. Group beta-hemolytic streptococcal (GBS) status should be determined and intrapartum antibiotic prophylaxis considered for pregnant women whose GBS culture status is unknown (culture not performed or result not available) and who also are likely to deliver before 37 weeks of gestation, have amniotic membranes that have been ruptured for $18 hours, or have an intrapartum temperature >100.4°F.

3. Patients are typically kept at modified bedrest and frequently assessed for evidence of infection or labor.

4. Tocolytics can be given to allow administration of antenatal corticosteroids and antibiotics.

5. Fetal surveillance consists of kick counts, nonstress tests, biophysical profiles (BPP). Abnormalities of these tests are predictive of fetal infection and umbilical cord compression related to oligohydramnios.

6. Fetal lung maturity. Antenatal corticosteroid administration is recommended for pregnancies complicated by PPROM at less than 32 weeks of gestation, as long as there is no clinical evidence of chorioamnionitis. A single course of corticosteroids should be administered. In more advanced gestations, fetal lung maturity tests may be performed via amniocentesis or on amniotic fluid samples aspirated from the vagina.

7. All patients with PPROM should be delivered at >32 weeks after confirmation of fetal lung maturity or a course of corticosteroids.

8. When there is confirmed fetal lung maturation at or beyond 32 weeks of gestation, the risks of expectant management often exceed those of delivery. Women with PPROM who are >32 weeks of gestation with a mature fetal lung profile are best managed by prompt induction of labor. Antibiotic prophylaxis for possible GBS colonization should be given during labor in the absence of a documented, recent negative GBS culture.

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