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.
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.