The American College of Obstetricians and Gynecologists (ACOG) has issued an interim update on the optimal method of initial management for a patient with prelabor rupture of membranes (PROM) at term. The document provides management guidelines that have been validated by appropriately conducted outcome-based research. Additional guidelines on the basis of consensus and expert opinion are also presented. Among the (Level A) recommendations:
- Patients with PROM before 34 0/7 weeks of gestation should be managed expectantly if no maternal or fetal contraindications exist.
- To reduce maternal and neonatal infections and gestational-age dependent morbidity, a 7-day course of therapy with a combination of intravenous ampicillin and erythromycin followed by oral amoxicillin and erythromycin is recommended during expectant management of women with preterm PROM who are less than 34 0/7 weeks of gestation.
- Women with preterm PROM and a viable fetus who are candidates for intrapartum GBS prophylaxis should receive intrapartum GBS prophylaxis to prevent vertical transmission regardless of earlier treatments.
- A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks and 34 0/7 weeks of gestation, and may be considered for pregnant women as early as 23 0/7 weeks of gestation who are at risk of preterm delivery within 7 days.
- Women with preterm PROM before 32 0/7 weeks of gestation who are thought to be at risk of imminent delivery should be considered candidates for fetal neuroprotective treatment with magnesium sulfate.
Prelabor rupture of membranes. ACOG Practice Bulletin No. 188. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e1–14.
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