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Expectant management of premature preterm rupture of membranes (PPROM) close to term is thought to raise risk for neonatal and maternal infection; thus, obstetric professional societies recommend immediate delivery for women with near-term PPROM. To better understand the risk–benefit balance of immediate delivery versus expectant management, 1839 women with PPROM at 34 weeks through 36 weeks 6 days' gestation were randomized to one of the two strategies.
The vast majority of women delivered within 5 days in the immediate delivery-group and 22 days in the expectant-management group. Immediate delivery was associated with higher rates of newborn respiratory distress syndrome (8% vs. 5%; P=0.008) and mechanical ventilation (12% vs. 9%; P=0.02) …