PROM dilemmas: Choosing a strategy, knowing when to call it quits

CASE resolved: Patient develops fever and spontaneous labor

Ten days after the documentation of PROM, J.S. reports a fever and abdominal tenderness, as well as frequent uterine contractions that began early in the day. She is admitted to the hospital. A physical examination confirms clinically apparent intra-amniotic infection and labor. The patient is started on IV antibiotics and, after a short labor, delivers a nonviable male infant weighing 500 g. Pathologic examination of the fetus and placenta reveals a normal, immature fetus with evidence of acute chorioamnionitis on placental sections.