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PPROM is a common complication of pregnancy occurring in about 3% of all pregnancies. The obstetrician needs to be familiar with appropriate management of PPROM. High-risk consultation with a maternal-fetal medicine subspecialist should be considered in all cases to ensure appropriate current therapy is instituted.
In general, the following guidelines should be followed:
ROM diagnosis needs to be confirmed.
Digital vaginal examinations should be avoided.
Ultrasonography should be performed to confirm gestational age, estimated fetal weight, presentation, amniotic fluid index, and fetal anatomy if not already fully evaluated.
Antibiotics need to be given based on present evidence. See Medical Treatment.
Corticosteroids should be given to accelerate lung maturity between 24 and 34 weeks.
Informed consent should be obtained for expectant management versus delivery with careful documentation in the chart.
In PPROM, the rule should be hospitalization after viability in an institution where care for a premature neonate can be provided.
Maternal health is the primary indicator for the need to deliver. Any evidence of infection or maternal instability due to complications of PPROM, such as bleeding, requires careful evaluation and determination of the appropriateness of expectant management.
Fetal monitoring should be performed at least daily until delivery, and fetal well being and growth should be evaluated periodically with ultrasonography.
After 32 weeks' and certainly after 34 weeks' gestation, the appropriateness of expectant management of PPROM should be reevaluated individually for each case.
PROM at term should be managed by delivery unless reasons exist to consider waiting for spontaneous labor. Large enough studies to document neonatal safety of expectant management of PROM at term do not exist.