October 2004 · Vol. 16, No. 10PPROM: New strategies for expectant management
Since antibiotics prolong latency in most cases, expectant management has become more feasible, with fewer morbidities at the time of delivery.
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Fast Track
History, nitrazine paper, and the fern pattern test are usually sufficient for a diagnosis.
Without evidence of fetal lung maturity, expectant management is advised between 32 and 34 weeks.
Recent reports disagree with earlier studies favoring cerclage removal.
ACOG: Limit outpatient management to study protocols.
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David
F.
Lewis,
MDProfessor and Chair, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport.
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KEY POINTS
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A large, prospective, randomized, controlled trial clearly showed that antibiotics decrease neonatal morbidities and prolong the interval between rupture of membranes and delivery.
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Avoid digital cervical examination during testing for rupture of membranes because it may hasten delivery and increase neonatal morbidity.
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Consider giving magnesium sulfate and corticosteroids to patients with preterm premature rupture of membranes at or beyond 23 weeks, provided there is no evidence of infection. After 32 weeks, deliver the infant if either intraamniotic infection or fetal lung maturity is present.
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At delivery, amnioinfusion decreases variable decelerations and improves pH when clinically indicated.
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The outlook for preterm premature rupture of membranes (PPROM) has improved considerably since a landmark study showed clear benefits of antibiotics.
Previously, approximately 80% of women with PPROM experienced spontaneous labor within 48 hours with expectant management.
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