Practice Guidelines

ACOG Guidelines on Premature Rupture of Membranes



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Am Fam Physician. 2008 Jan 15;77(2):245-246.

Guideline source: American College of Obstetricians and Gynecologists (ACOG)

Literature search described? Yes

Evidence rating system used? Yes

Published source: Obstetrics & Gynecology, April 2007

Available at: http://www.greenjournal.org/content/vol109/issue4/

Premature rupture of membranes (PROM) occurs in about one third of preterm births and can lead to significant perinatal morbidity and mortality. It typically is associated with brief latency between membrane rupture and delivery, increased risk of perinatal infection, and in utero umbilical cord compression. Management of PROM depends on gestational age and evaluation of the relative risks of preterm birth versus intrauterine infection, placental abruption, and cord complications that could occur with expectant management.

The decision on whether to deliver is based on gestational age and fetal status (Table 1). In women with PROM at term, labor should be induced immediately, generally with oxytocin (Pitocin) infusion, to reduce the risk of chorioamnionitis. Labor should be induced immediately, regardless of gestational age, in patients with intrauterine infection, placental abruption, or evidence of fetal compromise.

Table 1

Management of Premature Rupture of Membranes

Gestational age Management

Term (37 weeks or more)

Proceed to delivery

GBS prophylaxis recommended

Near term (34 to 36 weeks)

Same as above

Preterm (32 to 33 weeks)

Expectant management unless fetal pulmonary maturity is documented

GBS prophylaxis recommended

Antibiotics recommended to prolong latency, if no contraindications exist

Corticosteroids recommended by some experts, but no consensus exists

Preterm (24 to 31 weeks)

Expectant management

GBS prophylaxis recommended

Antibiotics recommended to prolong latency, if no contraindications exist

Single course of corticosteroids recommended

No consensus on use of tocolytics

Preterm (less than 24 weeks)*

Patient counseling

Expectant management or induction of labor

GBS prophylaxis not recommended

Data incomplete on the use of antibiotics to prolong latency

Corticosteroids not recommended


GBS = group B streptococcus.

*— The combination of birth weight, gestational age, and sex provides the best estimate of chances of survival and should be considered in individual cases.

Adapted with permission from American College of Obstetricians and Gynecologists. Premature rupture of membranes. ACOG practice bulletin no. 80. Obstet Gynecol. 2007;109(4):1011.

Table 1   Management of Premature Rupture of Membranes

View Table

Table 1

Management of Premature Rupture of Membranes

Gestational age Management

Term (37 weeks or more)

Proceed to delivery

GBS prophylaxis recommended

Near term (34 to 36 weeks)

Same as above

Preterm (32 to 33 weeks)

Expectant management unless fetal pulmonary maturity is documented

GBS prophylaxis recommended

Antibiotics recommended to prolong latency, if no contraindications exist

Corticosteroids recommended by some experts, but no consensus exists

Preterm (24 to 31 weeks)

Expectant management

GBS prophylaxis recommended

Antibiotics recommended to prolong latency, if no contraindications exist

Single course of corticosteroids recommended

No consensus on use of tocolytics

Preterm (less than 24 weeks)*

Patient counseling

Expectant management or induction of labor

GBS prophylaxis not recommended

Data incomplete on the use of antibiotics to prolong latency

Corticosteroids not recommended


GBS = group B streptococcus.

*— The combination of birth weight, gestational age, and sex provides the best estimate of chances of survival and should be considered in individual cases.

Adapted with permission from American College of Obstetricians and Gynecologists. Premature rupture of membranes. ACOG practice bulletin no. 80. Obstet Gynecol. 2007;109(4):1011.

Patients with PROM before 32 weeks' gestation should be cared for expectantly until they have completed 33 weeks of gestation, provided there are no maternal or fetal contraindications. Digital cervical examination should be avoided in patients with PROM unless they are in active labor or unless imminent delivery is anticipated.

Women with PROM before potential fetal viability should be counseled about the impact of immediate delivery and the risks and potential benefits of expectant management.

To prolong pregnancy and to reduce infectious and gestational age–dependent neonatal morbidity, a 48-hour course of intravenous ampicillin and erythromycin, followed by five days of amoxicillin and erythromycin, is recommended for expectant management of preterm PROM. All women with PROM and a viable fetus, including those who are known carriers of group B streptococcus (GBS) or who deliver before their GBS status can be determined, should receive intrapartum chemoprophylaxis to prevent vertical transmission of GBS. A single course of antenatal corticosteroids should be given to women with PROM at 24 to 31 weeks' gestation to reduce the risk of perinatal mortality, respiratory distress syndrome, and other morbidities.



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