ACOG practice bulletin. Premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Number 1, June 1998. American College of Obstetricians and Gynecologists

Abstract

The following recommendations are based on good and consistent scientific evidence (Level A): With term PROM, labor may be induced at the time of presentation or patients may be observed for up to 24-72 hours for the onset of spontaneous labor. Antibiotics prolong the latency period and improve perinatal outcome in patients with preterm PROM and should be administered according to one of several published protocols if expectant management is to be pursued prior to 35 weeks of gestation. Antenatal corticosteroids should be administered to gravidas with PROM before 32 weeks of gestation to reduce the risks of respiratory distress syndrome, neonatal intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death. Digital cervical examinations should not be performed in patients with PROM who are not in labor and in whom immediate induction of labor is not planned. Patients with PROM prior to 30-32 weeks of gestation should be managed conservatively if no maternal or fetal contraindications exist. The following recommendations are based primarily on consensus and expert opinion (Level C): Tocolysis may be utilized in patients with preterm PROM to permit administration of antenatal corticosteroids and antibiotics. Antenatal corticosteroids may be administered to gravidas with PROM up to 34 weeks of gestation.