Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial

“…2 There is substantial practice variation internationally particularly in women who present near term, beyond 34 weeks gestation. [3][4][5] Planned immediate delivery is both practiced 4 and recommended based upon conclusions that "compared with expectant management, induction of labor is associated with shorter latency to delivery and lower risk for maternal infection without excess risk for cesarean delivery". 6 This is despite recognition by professional bodies such as the American and British Colleges of Obstetricians and Gynecologists that such recommendations are "based on limited and inconsistent scientific evidence.…”

Neonatal outcomes are associated with latency after preterm premature rupture of membranes

“…4,6,7 Although observed increases in maternal and neonatal morbidity with ruptured membranes >24 h in term pregnancy have led to a consensus regarding induction of labor as standard of care, 8 there is currently no consensus regarding the optimal GA for labor induction and delivery after PPROM. [9][10][11] Several studies have shown increased latency and increased rates of chorioamnionitis in late preterm PPROM women managed expectantly, but found no differences in major neonatal morbidity and mortality, regardless of whether testing for pulmonary maturity was performed. [12][13][14][15] A meta-analysis of these studies recommended an approach of immediate induction of labor for all PPROM women >30 weeks GA or with confirmed pulmonary maturity, although this was mainly shown to benefit maternal morbidity rather than improving neonatal outcome.…”

“…A common approach is the immediate induction once pulmonary maturity is confirmed: this would be after a course of corticosteroids in stable PPROM between 32 to 34 weeks GA or any PPROM after 34 weeks GA. [31][32][33] Although the American College of Obstetrics and Gynecology guideline strongly favours induction of labor after 34 weeks gestation, 18 this practice is not yet universally accepted and 42% of the 508 maternal-fetal medicine specialists surveyed in the US continue expectant management beyond this GA. 9 Clearly there remains a gray zone between 32 to 34 weeks GA that requires further investigation. For management of late-preterm PPROM, a sufficiently large and updated randomized control trial with assessment of long-term outcome is needed to help delineate guidelines for obstetricians who regularly face the challenge of managing the complexities of this clinical population.…”

456: The effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes

“…In the mid 1990s, it appeared that tocolytic use after PPROM was increasing, with nearly 75% of clinicians in the U.S. and abroad either using or would consider using tocolytic therapy. 6,[16][17] In a survey of 731 Fellows and Members of the Royal College of Obstetricians and Gynecologists of Australia and New Zealand, 75% of obstetricians administered tocolytic therapy after PPROM. 15 Similarly, Ramsey et al, 6 in a survey of 1375 maternal fetal medicine specialists, found that tocolytic agents were used by 73% of subspecialists.…”

“…In contemporary practice, conservative management of PPROM may include antibiotic administration to prolong latency, corticosteroid use to reduce prematurity related neonatal morbidity, and tocolytic therapy. 1,[4][5][6] Preterm birth is a risk factor for cerebral palsy, a condition characterized by abnormal control of movement and posture that results in limitation of activity. Currently, one third of cases of cerebral palsy are associated with early preterm birth.…”