Selected issues in premature rupture of the membranes: herpes, cerclage, twins, tocolysis, and hospitalization

Abstract

A number of issues related to premature rupture of the membranes (PROM) are less common or have not been thoroughly evaluated. Genital herpes simplex colonization carries the potential for significant perinatal morbidity, particularly with primary infection and membrane rupture. Cervical cerclage is both a risk factor for preterm PROM (pPROM) and confounds the management of women with PROM. Twin gestations carry an increased risk of pPROM and earlier membrane rupture. Membrane rupture can involve the presenting or nonpresenting sac. In each case, the fetus with intact membranes is at risk due to brief latency or intrauterine infection after membrane rupture of its sibling. Prophylactic and therapeutic tocolysis remains controversial because of the high risk of intrauterine infection after PROM, and the lack of data demonstrating long-term efficacy. With increased attention to health care costs, home management of pPROM has recently been suggested as an alternative to hospitalization after pPROM. This article reviews the clinical course and management options regarding these issues. Also discussed are those issues for which there is controversy but little available data. Each of these issues offers fruitful ground for discussion and further study.