PPROM in the late preterm period: an argument against expectant management.

Abstract

Preterm premature rupture of membranes (PPROM), defined as leaking of amniotic fluid through the cervical os before 37 weeks and prior to the onset of labor, complicates nearly 3% of deliveries and 30% of indicated late preterm deliveries[1]. Current management of PPROM which occurs between 34 to 36 weeks' gestation has pivoted from recommending delivery to recommending either delivery or expectant management because of a large trial which evaluated these management strategies. The potential neonatal benefits of expectant management, reducing complications of prematurity, must be weighed with the maternal risks (and therefore attached neonatal risks) of prolonging the gestation under close surveillance. We recommend immediate delivery for PPROM occurring at or later than 34 weeks of gestation, given higher risk of maternal complications, specifically hemorrhage and infection, associated with expectant management. Furthermore, limited evidence exists to prove increased risks of adverse neonatal outcomes, including sepsis or composite neonatal morbidity, with immediate delivery when compared to expectant management.