Preterm premature rupture of membranes in the late preterm period: an argument against expectant management

Preterm premature rupture of membranes is defined as the leakage of amniotic fluid through the cervical os before 37 weeks of gestation and before the onset of labor and complicates nearly 3% of deliveries and 30% of indicated late preterm deliveries. The current management of preterm premature rupture of membranes, which occurs between 34 and 36 weeks of gestation, has pivoted from recommending delivery to recommending either delivery or expectant management because of a large trial that 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. Proceeding towards delivery is recommended for preterm premature rupture of membranes occurring at or later than 34 weeks gestation, given the higher risk of maternal complications, specifically hemorrhage and infection, with expectant management. Furthermore, limited evidence exists to prove the increased risks of adverse neonatal outcomes, including sepsis or composite neonatal morbidity, with immediate delivery compared with expectant management.