What are the management options for premature preterm rupture of membranes (PPROM)?

Updated: Oct 05, 2018
  • Author: Allahyar Jazayeri, MD, PhD, FACOG, DACOG, FSMFM; Chief Editor: Carl V Smith, MD  more...
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The initial evaluation of premature preterm rupture of membranes (PPROM) should include a sterile speculum examination to document ROM. Cervical cultures including Chlamydia trachomatis and Neisseria gonorrhoeae and anovaginal cultures for Streptococcus agalactiae should be obtained. Maternal vital signs should be documented as well as continuous fetal monitoring initially to establish fetal status. Ultrasonographic documentation of gestational age, fetal weight, fetal presentation, and amniotic fluid index should be established. Digital examination should be avoided, but visual inspection of the cervix can accurately estimate cervical dilatation. Digital examination of the cervix with PPROM has been shown to shorten latency and increase risk of infections without providing any additional useful clinical information. [14]

In certain circumstances, immediate delivery of the fetus with PPROM is indicated. These circumstances include chorioamnionitis, advanced labor, fetal distress, and placental abruption with nonreassuring fetal surveillance. If fetal lung maturity has been documented by either amniocentesis or collection of vaginal fluid, delivery should be facilitated. In a noncephalic fetus with advanced cervical dilatation (more than or equal to 3 cm), the risk of cord prolapse may also outweigh the benefits of expectant management and delivery should be considered.

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