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Expectant and active management of preterm premature rupture of membranes
1Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City.
Optimal management of PPROM remains controversial. Expectant management is a viable alternative only if there is no evidence of infection, advanced labor, or fetal distress. In these cases, aggressive intervention is appropriate, regardless of gestational age. The goal of expectant management is the achievement of increased gestational age at the time of delivery, given the tremendous potential advantage to be gained during the period between 26 and 34 weeks' gestation, an interval during which perinatal mortality decreases sharply. The potential value of corticosteroids and prophylactic antibiotics is discussed elsewhere in this issue. The power limitations of the previous studies, which considered amniocentesis and tocolytic therapy, preclude firm conclusions and enthusiastic recommendation for their routine inclusion in the expectant management of PPROM.
Optimal management of PPROM remains controversial. Expectant management is a viable alternative only if there is no evidence of infection, advanced labor, or fetal distress. In these cases, aggressive intervention is appropriate, regardless of gestational age. The goal of expectant management is the achievement of increased gestational age at the time of delivery, given the tremendous potential advantage to be gained during the period between 26 and 34 weeks' gestation, an interval during which perinatal mortality decreases sharply. The potential value of corticosteroids and prophylactic antibiotics is discussed elsewhere in this issue. The power limitations of the previous studies, which considered amniocentesis and tocolytic therapy, preclude firm conclusions and enthusiastic recommendation for their routine inclusion in the expectant management of PPROM.