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ACOG Practice Bulletin No. 188: Prelabor Rupture of Membranes
Insights
Preterm prelabor rupture of membranes (PROM) affects 3% of US pregnancies, complicating delivery. Management guidelines are reviewed, balancing delivery risks against expectant management for optimal maternal and fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Maternal-Fetal Medicine
Background:
- Preterm delivery is a significant cause of perinatal morbidity and mortality in the US, occurring in about 12% of births.
- Preterm prelabor rupture of membranes (PROM) complicates roughly 3% of all pregnancies.
- Current clinical assessment and treatment strategies for PROM are subjects of ongoing debate.
Purpose of the Study:
- To review the current understanding of preterm prelabor rupture of membranes (PROM).
- To provide evidence-based management guidelines for PROM, incorporating outcome research.
- To present guidelines based on expert consensus where outcome data are limited.
Main Methods:
- Literature review of outcome-based research on PROM management.
- Synthesis of current understanding of PROM pathophysiology and risks.
- Development of clinical guidelines based on available evidence and expert opinion.
Main Results:
- Management decisions for PROM require careful consideration of gestational age.
- Risk assessment involves weighing the dangers of delivery against expectant management (e.g., infection, placental abruption, cord accidents).
- Guidelines aim to optimize clinical decision-making for PROM cases.
Conclusions:
- Optimal management of PROM remains controversial and requires individualized assessment.
- Guidelines are provided to support clinical decision-making in PROM.
- Balancing maternal and fetal risks is central to PROM management strategies.
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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