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    Practice Bulletin Summary: Premature Rupture of Membranes

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    Practice Bulletin Summary: Premature Rupture of Membranes

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    Fernando Espinoza
    30 views3 pages
    Lo de siempre.

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    2016 Update

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    Lo de siempre.

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    30 views3 pages

    Practice Bulletin Summary: Premature Rupture of Membranes

    Uploaded by

    Fernando Espinoza
    Lo de siempre.

    Copyright:

    © All Rights Reserved
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    interim update

    The American College of


    Obstetricians and Gynecologists
    WOMEN’S HEALTH CARE PHYSICIANS

    P RACTICE BULLET IN SUMMARY


    clinical management guidelines for obstetrician – gynecologists

    Number 160, January 2016 (Replaces Practice Bulletin Number 139, October 2013)

    For a comprehensive overview of premature rupture of membranes, the full-text Scan this QR code
    version of this Practice Bulletin is available at http://dx.doi.org/10.1097/ with your smart
    phone to view the
    AOG.0000000000001266.
    full-text version of
    this Practice Bulletin.
    Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the Committee on
    Practice Bulletins—Obstetrics with the assistance of Robert Ehsanipoor, MD. The information is designed to aid practitioners in making decisions about
    appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations
    in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.

    INTERIM UPDATE: This Practice Bulletin is updated to reflect a limited, focused change in gestational age at which to
    consider antenatal corticosteroids.

    Premature Rupture of Membranes


    Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes
    to perinatal morbidity and mortality (1, 2). Preterm premature rupture of membranes (PROM) complicates approxi-
    mately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of
    women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and
    evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae,
    and umbilical cord accident). The purpose of this document is to review the current understanding of this condition
    and to provide management guidelines that have been validated by appropriately conducted outcome-based research
    when available. Additional guidelines on the basis of consensus and expert opinion also are presented.

    Clinical Management Questions


    How is premature rupture of membranes diagnosed?
    What does the initial management involve once PROM has been confirmed?
    What is the optimal method of initial management for a patient with PROM at term?
    When is delivery recommended for the preterm fetus in the presence of premature rupture
    of membranes?
    What general approaches are used in cases of preterm PROM managed expectantly?
    Should tocolytics be considered for patients with preterm PROM?
    Should antenatal corticosteroids be administered to patients with preterm PROM?
    Should magnesium sulfate for fetal neuroprotection be administered to patients with preterm PROM?

    192 VOL. 127, NO. 1, JANUARY 2016 OBSTETRICS & GYNECOLOGY

    Copyright ª by The American College of Obstetricians


    and Gynecologists. Published by Wolters Kluwer Health, Inc.
    Unauthorized reproduction of this article is prohibited.
    Should antibiotics be administered to patients with preterm PROM?
    Should preterm PROM be managed with home care?
    How should a patient with preterm PROM and a cervical cerclage be treated?
    What is the optimal management of a patient with preterm PROM and herpes simplex virus infection
    or human immunodeficiency virus?
    How does care differ for patients with PROM that occurs before neonatal viability?
    What is the expected outcome of PROM after second-trimester amniocentesis?
    How should a patient with a history of preterm PROM be managed in future pregnancies?

    Recommendations and near the time of presentation in those who do not


    have contraindications to labor, labor should be
    Conclusions induced.
    The following recommendations are based on At 34 0/7 weeks or greater gestation, delivery is rec­
    good and consistent scientific evidence (Level A): ommended for all women with ruptured membranes.
    In the setting of ruptured membranes with active
    Patients with PROM before 34 0/7 weeks of gesta­ labor, therapeutic tocolysis has not been shown to
    tion should be managed expectantly if no maternal prolong latency or improve neonatal outcomes.
    or fetal contraindications exist. Therefore, therapeutic tocolysis is not recommended.
    To reduce maternal and neonatal infections and
    gestational-age dependent morbidity, a 7-day course The following conclusion is based primarily on
    of therapy with a combination of erythromycin and consensus and expert opinion (Level C):
    ampicillin or amoxicillin is recommended during
    The outpatient management of preterm PROM with
    expectant management of women with preterm a viable fetus has not been sufficiently studied to
    PROM who are less than 34 0/7 weeks of gestation. establish safety and, therefore, is not recommended.
    Women with preterm PROM and a viable fetus
    who are candidates for intrapartum GBS prophy-
    laxis should receive intrapartum GBS prophylaxis
    Proposed Performance
    to prevent vertical transmission regardless of earlier Measure
    treatments. The percentage of expectantly managed patients with
    A single course of corticosteroids is recommended preterm PROM (up to 34 0/7 weeks of gestation) that
    for pregnant women between 24 0/7 weeks and 34 receive latency antibiotics and corticosteroids
    0/7 weeks of gestation, and may be considered for
    pregnant women as early as 23 0/7 weeks of gesta­
    tion who are at risk of preterm delivery.
    Women with preterm PROM before 32 0/7 weeks of Studies were reviewed and evaluated for qual­i­ty ac­cord­ing
    gestation who are thought to be at risk of imminent to the method outlined by the U.S. Pre­ven­tive Services
    delivery should be considered candidates for fetal Task Force. Based on the highest level of evidence found
    neuroprotective treatment with intravenous magne­ in the data, recommendations are provided and grad­ ed
    sium sulfate. ac­cord­ing to the following categories:
    Level A—Recommendations are based on good and con­
    The following recommendations and conclusions sis­tent sci­en­tif­ic evidence.
    are based on limited and inconsistent scientific Level B—Recommendations are based on limited or
    evidence (Level B): in­con­sis­tent scientific evidence.
    Level C—Recommendations are based primarily on con­
    For women with PROM at 37 0/7 weeks of gesta­ sen­sus and expert opinion.
    tion or more, if spontaneous labor does not occur

    VOL. 127, NO. 1, JANUARY 2016 Practice Bulletin No. 160 Summary 193

    Copyright ª by The American College of Obstetricians


    and Gynecologists. Published by Wolters Kluwer Health, Inc.
    Unauthorized reproduction of this article is prohibited.
    Copyright January 2016 by the American College of Ob­ste-­
    tri­cians and Gynecologists. All rights reserved. No part of this
    publication may be reproduced, stored in a re­triev­al sys­tem,
    posted on the Internet, or transmitted, in any form or by any
    means, elec­tron­ic, me­chan­i­cal, photocopying, recording, or
    oth­er­wise, without prior written permission from the publisher.
    The American College of Obstetricians and Gynecologists
    409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920
    Official Citation
    Premature rupture of membranes. Practice Bulletin No. 160. American
    College of Obstetricians and Gynecologists. Obstet Gynecol 2016;
    127:e39–51.

    194 Practice Bulletin No. 160 Summary OBSTETRICS & GYNECOLOGY

    Copyright ª by The American College of Obstetricians


    and Gynecologists. Published by Wolters Kluwer Health, Inc.
    Unauthorized reproduction of this article is prohibited.

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