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Preterm Premature Rupture of the Membranes

Mercer, Brian M. MD

High-Risk Pregnancy Series: An Expert's View

Preterm premature rupture of membranes (PROM) affects over 120,000 pregnancies annually in the United States and is associated with significant maternal, fetal, and neonatal risk. Management of PROM requires an accurate diagnosis as well as evaluation of the risks and benefits of continued pregnancy or expeditious delivery. An understanding of gestational age-dependent neonatal morbidity and mortality is important in determining the potential benefits of conservative management of preterm PROM at any gestation. Where possible, the treatment of pregnancies complicated by PROM remote from term should be directed towards conserving the pregnancy and reducing perinatal morbidity due to prematurity while monitoring closely for evidence of infection, placental abruption, labor, or fetal compromise due to umbilical cord compression. Current evidence suggests aggressive adjunctive antibiotic therapy to reduce gestational age-dependent and infectious infant morbidity. Similarly, review of evaluable data indicates that antenatal corticosteroid administration in this setting enhances neonatal outcome without increasing the risk of perinatal infection. It is not clear that tocolysis in the setting of preterm PROM remote from term reduces infant morbidity. When preterm PROM occurs near term, particularly if fetal pulmonary maturity is evident, the patient is generally best served by expeditious delivery.

From the Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.

Support: The Prematurity Center of The Partnership for Women's and Children's Health (University of Tennessee, Memphis; Methodist Healthcare Foundation; LeBonheur Children's Hospital; and the Tennessee Coordinated Care Network).

We would like to thank the following individuals who, in addition to members of our Editorial Board, will serve as referees for this series: Dwight P. Cruikshank, MD, Ronald S. Gibbs, MD, Gary D. V. Hankins, MD, Philip B. Mead, MD, Kenneth L. Noller, MD, Catherine Y. Spong, MD, and Edward E. Wallach, MD.

We have invited select authorities to present background information on challenging clinical problems and practical information on diagnosis and treatment for use by practitioners.

Reprints are not available. Address correspondence to: Brian M. Mercer, MD, MetroHealth Medical Center, Department of Obstetrics and Gynecology, 2500 MetroHealth Drive, Suite G240, Cleveland, OH 44109-1989.

Received May 28, 2002. Received in revised form July 18, 2002. Accepted August 8, 2002.

© 2003 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.