What is the primary maternal risk of expectant management 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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If after initial evaluation of the mother and fetus, they are both determined to be clinically stable, expectant management of PPROM may be considered to improve fetal outcome. The primary maternal risk with expectant management of PPROM is infection. This includes chorioamnionitis (13-60%), endometritis (2-13%), sepsis (< 1%), and maternal death (1-2 cases per 1000). Complications related to the placenta include abruption (4-12%) and retained placenta or postpartum hemorrhage requiring uterine curettage (12%). [3]

The risks and potential benefits of expectant management should be discussed with the patient and her family, and informed consent should be obtained. The maternal and fetal status need to be reevaluated daily, and the safety and potential benefits of expectant management should be reassessed. If the condition remains stable, the immature fetus may benefit from expectant management, even if for a short period, to allow administration of steroids and antibiotics. Once maturity has been reached, the benefit from expectant management of PPROM is unclear and the risks of infection outweigh any potential benefits.

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