Management of Premature Rupture of Membrane During Pregnancy (PROM)
Premature rupture of fetal membranes (PROM) is estimated to occur in between 8-10% of all pregnancies.1 Consequences of PROM can include fetal distress, infection, umbilical cord prolapse and placental abruption. Various methods have been suggested for managing the risks associated with PROM.
One of the largest deciding factors to manage premature rupture of membranes by inducing labor is gestational age. In cases of PROM occurring at 37 weeks or later, induction of labor is most recommended. The further along in pregnancy PROM occurs, the shorter the latent period between the rupture and labor will be. Management of preterm premature rupture of membranes (PROM occurring before 37 weeks, known as pPROM), is somewhat more complicated. Then, the physician must balance the risks of inducing premature delivery with the effectiveness of medical intervention for treating complications of the condition (risk of infection).
Clinical management guidelines for obstetrician-gynecologists suggest that, “labor induction clearly is beneficial at or after 34 weeks’ gestation.”2 Between 32 and 33 weeks, induction should be considered only if pulmonary maturity has been documented and adequate resources are available for the monitoring and care of premature neonates.
Management of Premature Rupture of Membranes With Drugs
In cases where the early induction of labor is not possible, medication is recommended to manage the premature rupture of membrane risk factors. These include:
- Corticosteroids: A single course of corticosteroids (typically either betamethasone or dexamethasone, administered intramuscularly) can reduce the risk of respiratory distress syndrome, intraventricular hemorrhage and necrotizing enterocolitis.3 Corticosteroids are generally recommended only for a gestation age of 32 weeks or fewer.
- AntibioticsAntibiotics can be useful in reducing the risk of infection and neonatal sepsis associated with premature rupture of membranes. Evidence also suggests that antibiotics can prolong the latent period between PROM and the onset of labor.4
- Caughey, AB et al. Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes. Rev. Obstet. Gynecol. 2008;1(1):11–22.
- Medina T, Hill DA. Preterm Premature Rupture of Membranes: Diagnosis and Management. Am Fam Physician. 2006 Feb 15;73(4):659-664.
- Harding JE et al. Do antenatal corticosteroids help in the setting of preterm rupture of membranes?. Am J Obstet Gynecol. 2001;184:131–9.
- Mercer BM, Arheart KL. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Lancet. 1995;346:1271–9.