Diagnosis and Management of Preterm Prelabor Rupture of Membranes: A Comprehensive Review of Major Guidelines.

Abstract

Importance: Preterm prelabor rupture of membranes (PPROM) represents a significant contributor of maternal and neonatal morbidity complicating a significant proportion of pregnancies worldwide.

Objective: The aim of this review was to summarize and compare the most recently published guidelines on the diagnosis and management of this critical pregnancy complication.

Evidence acquisition: A comparative review of 3 recently updated national guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada on PPROM was conducted.

Results: There is an overall agreement that the diagnosis of PPROM should be mainly based on sterile speculum examination and patient's history, followed by additional tests in equivocal cases, although the accuracy and contribution of both ultrasound and amniotic proteins tests in the diagnosis remain debatable. Following PPROM confirmation, all guidelines recommend the performance of vaginal and rectal swabs, the evaluation of fetal and maternal status, the administration of antibiotics and corticosteroids, and the immediate induction of labor, if severe complications are identified. Expectant management from viability until late preterm period is universally recommended; nevertheless, there are discrepancies on the optimal timing of delivery. Magnesium sulfate should be administered in case of imminent preterm delivery; however, there is no consensus on the upper gestational age limit. Recommendations on inpatient and outpatient management of PPROM are also inconsistent. Moreover, there is no common guidance on the use of tocolysis or antibiotic regimens. Finally, all medical societies agree that closer surveillance of future pregnancies is required.

Conclusions: PPROM remains the most common identifiable risk factor of preterm delivery, despite constant improvement in prenatal provision of care. Thus, the establishment of consistent international practice protocols for the timely and accurate diagnosis and the optimal management of this complication seems of vital importance and will hopefully lead to significant reduction of the associated adverse outcomes.