Management of preterm premature rupture of the membranes

In many cases, the management of preterm PROM will be dictated by the presence of advanced labor, intrauterine infection, placental abruption, or nonreassuring fetal testing. These patients should be delivered expeditiously, with group B streptococcus prophylaxis given where possible, and cesarean delivery reserved for routine obstetric indications. The stable patient with PPROM and documented fetal pulmonary maturity is best treated by early induction. Alternatively, the patient with PPROM remote from term can benefit from conservative treatment. Adjunctive antibiotic treatment and serial evaluation of maternal and fetal well-being offer significant potential for the reduction of perinatal morbidity. Although corticosteroid and tocolytic administration remain controversial, there is a theoretical benefit to their administration, particularly if concurrent antibiotic treatment is given to treat subclinical intrauterine infection.