Management of Premature Rupture of Membranes

Target Population: Obstetric care providers

Background and Objective

Most women with premature rupture of membranes (PROM) at term will deliver within 28 hours; for preterm PROM (PPROM), half of women will deliver within 1 week. ACOG has updated its recommendations for management of PROM.

Key Recommendations

Term and Early Term PROM (>37 0/7 weeks); Late PPROM (34 0/7–36 6/7 weeks)

• Compared with expectant management, induction of labor is associated with shorter latency to delivery and lower risk for maternal infection without excess risk for cesarean delivery.

• Candidates for vaginal delivery should be offered immediate induction, generally with oxytocin.

• For women who decline induction, expectant management with close monitoring and informed consent is reasonable.

• Intrapartum prophylaxis for group B streptococci (GBS) should be administered to at-risk women.

PPROM (24 0/7–33 6/7 weeks)

• Expectant management is recommended; indications for delivery include nonreassuring fetal status, chorioamnionitis, and placental abruption.

• A single course of antenatal glucocorticoids should be given to lower risk for respiratory distress syndrome and other morbidities associated with prematurity.

• Magnesium sulfate for fetal neuroprotection should be considered if delivery seems imminent before 32 0/7 weeks' gestation.

• A 7-day course of antibiotics to prolong pregnancy is advised.

• Intrapartum prophylaxis for GBS should be administered to at-risk women.

Previable PPROM (<24 0/7 weeks)

• Risk for perinatal death is nearly 60%, and risk for pulmonary hypoplasia approaches 20%.

• Likelihood of maternal infection and bleeding complications is substantial.

• Women should be counseled about the risks associated with continuing a pregnancy after previable PPROM; pregnancy termination should be offered.

• Outpatient expectant management can be considered; latency antibiotics, glucocorticoids, and tocolytics have no role before 24 completed weeks' gestation.

• Outcomes are remarkably better for amniocentesis-related (vs. spontaneous) second-trimester PPROM.