Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
For a comprehensive overview of premature rupture of membranes, the full-text version of this Practice Bulletin is available at http://dx.doi.org/10.1097/AOG.0000000000001712.
Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics in collaboration with Robert Ehsanipoor, MD.
The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.
INTERIM UPDATE: This Practice Bulletin is updated to reflect a limited, focused change to clarify that antenatal corticosteroids should be administered when a woman is at risk of preterm delivery within 7 days. For complete details on these updates, please see the full-text version.
Copyright October 2016 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
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Official Citation: Premature rupture of membranes. Practice Bulletin No. 172. American College of Obstetricians and Gynecologists. Obstet Gynecol 2016; 128:e165–77.
Received August 24, 2016
Accepted August 24, 2016