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ACOG Practice Bulletin No. 188 Summary: Prelabor Rupture of Membranes
Insights
Preterm prelabor rupture of membranes (PROM) affects 3% of US pregnancies. Management guidelines are presented, balancing delivery risks against expectant management to reduce perinatal morbidity and mortality.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
Background:
- Preterm delivery is a significant cause of perinatal morbidity and mortality in the US, occurring in 12% of births.
- Preterm prelabor rupture of membranes (PROM) complicates approximately 3% of all pregnancies.
- Optimal clinical assessment and treatment strategies for PROM remain a subject of debate.
Purpose of the Study:
- To review current understanding of PROM.
- To provide evidence-based management guidelines for PROM.
- To present guidelines based on consensus and expert opinion where outcome-based research is limited.
Main Methods:
- Literature review of current understanding and management of PROM.
- Analysis of risks associated with delivery versus expectant management.
- Synthesis of outcome-based research and expert consensus.
Main Results:
- Management decisions for PROM depend on gestational age.
- Key considerations include risks of infection, abruptio placentae, and umbilical cord accidents with expectant management.
- Guidelines aim to optimize outcomes for both mother and neonate.
Conclusions:
- Effective management of PROM requires careful consideration of gestational age and associated risks.
- Evidence-based guidelines, supplemented by expert opinion, are crucial for optimizing PROM care.
- Addressing PROM is vital for reducing preterm birth complications.
Abstract:
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor that contributes to perinatal morbidity and mortality (1, 2). Preterm prelabor rupture of membranes (also referred to as premature rupture of membranes) (PROM) complicates approximately 3% of all pregnancies in the United States (3). The optimal approach to clinical assessment and treatment of women with term and preterm PROM remains controversial. Management hinges on knowledge of gestational age and evaluation of the relative risks of delivery versus the risks of expectant management (eg, infection, abruptio placentae, and umbilical cord accident). The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented.
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