Evaluation and management of preterm premature rupture of membranes

A simplified management algorithm—based on gestational age, fetal stability, and maternal infection—guides the clinician through the best options.

Dr. Duff is professor of obstetrics and gynecology, resident program director, and associate dean for student affairs, department of obstetrics and gynecology, division of maternal-fetal medicine, University of Florida College of Medicine,  Gainesville, Fla.

Management of preterm premature rupture of membranes (PPROM) is the most controversial of all obstetric problems. This article describes an algorithmic approach (FIGURE) to evaluation and treatment.

PPROM refers to rupture of membranes before onset of contractions at a gestational age less than 37 weeks. Approximately 30% to 40% of preterm deliveries are associated with PPROM.¹ In turn, preterm delivery is responsible for approximately 75% of all neonatal deaths, excluding infants with anomalies incompatible with life.²