Management of Preterm Premature Rupture of Membranes in the Late Preterm Period

Abstract

Importance 

For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.

Objective 

In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).

Evidence Acquisition 

Original research articles, review articles, and guidelines on management of late PPROM.

Results 

Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.

Conclusions and Relevance 

We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.

Target Audience 

Obstetricians and gynecologists, family physicians.

Learning Objectives 

After participating in this activity, the provider should be better able to summarize current evidence regarding fetal, maternal, and obstetric outcomes between immediate delivery and expectant management of patients with PPROM in the late preterm period; describe clinical evaluation of women who present with PPROM in the late preterm period; and plan adequate counseling on the risk and benefits of immediate delivery or expectant management to women who present with PPROM in the later preterm period.