34週以降の妊娠継続管理は、前期前期破水に対して提供されるべきである

Delivery timing for preterm prelabour rupture of membranes (PPROM) was historically recommended at 34-weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34-weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remains mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the national published guidelines, and discuss our opinion of the controversy as well as future direction for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34-weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and worse, if not universally offered in the appropriate setting, may be an area of inequitable or biased care.