How long is prolonged rupture of membranes

Am J Perinatol ; 30 : 69— PubMed Google Scholar. Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios. Early Hum Dev ; 85 : — The management of preterm premature rupture of the membranes near the limit of fetal viability. Taylor J, Garite TJ. Premature rupture of membranes before fetal viability. Obstet Gynecol ; 64 : — Outcomes following prolonged preterm premature rupture of the membranes. Rupture of membranes before the age of viability and birth after the age of viability: comparison of outcomes in a matched cohort study.

J Perinatol ; 30 : — Antibiotics for preterm rupture of membranes. Google Scholar. White matter injury following fetal inflammatory response syndrome induced by chorioamnionitis and fetal sepsis: lessons from experimental ovine models. Early Hum Dev ; 88 : — The association of histological chorioamnionitis and antenatal steroids on neonatal outcome in preterm infants born at less than thirty-four weeks' gestation.

Neonatology ; : — Chorioamnionitis—the good or the evil for neonatal outcome? Histological chorioamnionitis is associated with cerebral palsy in preterm neonates.

Chorioamnionitis and prematurity: a critical review. Gynecol Endocrinol ; 27 : — Preterm premature rupture of membranes: does the duration of latency influence perinatal outcomes? Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern-Fetal Neonatal Med ; 22 : — Waters TP, Mercer B.

Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol ; 54 : — Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gynecol ; : Conservative management of preterm premature rupture of membranes between 18 and 23 weeks of gestation—maternal and neonatal outcome.

Perinatal outcome following conservative management of mid-trimester pre-labour rupture of the membranes. J Paediatr Child Health ; 33 : — Cognitive impairment at age 5 years in very preterm infants born following premature rupture of membranes. J Pediatr ; : — Consider obtaining a screening CBC with differential at birth and at a minimum of 6- 12 hrs of life. If the infant shows clinical signs of illness, a sepsis work-up as outlined below should be performed.

If the infant shows clinical signs of illness, a sepsis work-up should be performed. If a sepsis work-up has been performed, the infant should be reassessed at 48 hours. Physicians should advise patients and family members that, despite these efforts, many patients deliver within one week of preterm PROM. Physicians should administer a course of corticosteroids and antibiotics and perform an assessment of fetal well-being by fetal monitoring or ultrasonography. In addition, the physician should observe closely for fetal or maternal tachycardia, oral temperature exceeding Corticosteroid administration may lead to an elevated leukocyte count if given within five to seven days of PROM.

Evidence suggests that prolonged latency may increase the risk of intra-amniotic infection. Delivery is necessary for patients with evidence of amnionitis. If the diagnosis of an intrauterine infection is suspected but not established, amniocentesis can be performed to check for a decreased glucose level or a positive Gram stain and differential count can be performed. The incidence of this syndrome is related to the gestational age at which rupture occurs and to the level of oligohydramnios.

Physicians caring for patients with preterm PROM before viability may wish to obtain consultation with a perinatologist or neonatologist. Such patients, if they are stable, may benefit from transport to a tertiary facility. Home management of patients with preterm PROM is controversial. A study 33 of patients with preterm PROM randomized to home versus hospital management revealed that only 18 percent of patients met criteria for safe home management.

Bed rest at home before viability i. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Medina completed a fellowship in family practice obstetrics at Florida Hospital, Orlando. Address correspondence to D. Ashley Hill, M. Reprints are not available from the authors.

Causes of low birth weight births in public and private patients. Am J Obstet Gynecol. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N Engl J Med. Midtrimester premature rupture of the membranes. Semin Perinatol. American College of Obstetricians and Gynecologists. Premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists.

ACOG practice bulletin no. Int J Gynaecol Obstet. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. Clinical utility of the nonstress test in the conservative management of women with preterm spontaneous premature rupture of the membranes.

J Reprod Med. Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis. Does prolonged preterm premature rupture of the membranes predispose to abruptio placentae?.

Epidemiologic characteristics of preterm delivery: etiologic heterogeneity. All investigators routinely excluded from assessment patients who had any medical or obstetric complication of pregnancy that warranted immediate intervention, such as hypertension, insulin-dependent diabetes, postdates pregnancy, malpresentation, or fetal anomaly.

All investigators observed patients in the hospital under a strict protocol that provided for fetal heart rate testing and surveillance for maternal infection. Cultures of the lower genital tract, assessment of the peripheral white blood cell count, and evaluation of maternal temperature were the measures most consistently employed to detect maternal infection.

The authors intervened promptly by inducing labor if evidence of maternal infection developed. They also recognized that their study patients were likely to have very long latent phases and made a determined effort to minimize the number of vaginal examinations in the early portion of labor. Finally, none of the authors used laminaria, dilapan, or topical prostaglandin preparations as cervical-ripening agents.

A number of reports have appeared in the literature describing use of prostaglandin preparations in management of patients with PROM and an unfavorable cervix. Taken together, these publications have highlighted and refined a valuable new approach to patients with this troublesome complication. Granstrom and associates 34 were among the first to evaluate the efficacy of prostaglandin E 2 PGE 2 for cervical ripening and labor induction in patients with PROM and an unfavorable cervix.

The cervical examination was reassessed 5 and 24 hours later. If the cervix was favorable but no contractions were present, labor was induced with oxytocin. If the cervix was still unfavorable, a second suppository was administered. Twelve of the nulliparous women and 21 of the multiparous women were in labor within 5 hours of application of the first suppository.

The mean application-to-regular contractions interval and onset of labor-to-delivery interval were 11 and 5. No maternal or neonatal infections occurred. The dose of prostaglandin was repeated every 6 hours up to a maximum of three doses. The mean duration of labor was longest in the oxytocin group, and all six cesarean deliveries were in these patients. There was no significant difference in the frequency of maternal or neonatal infection.

Women in the prostaglandin group had the shortest length of hospitalization. Goeschen 36 conducted a clinical trial comparing induction of labor with oxytocin versus PGE 2. The gel was applied intracervically in a dose of 0. In addition, the incidence of operative delivery and the frequency of neonatal infection were lower in the prostaglandin group. Patients were randomly assigned to placebo suppository versus 3-mg PGE 2 suppository vs. The dose of PGE 2 was repeated in 6 hours if the patient was not in labor.

Oxytocin was administered after 12 additional hours if the patient was still not in labor. Patients who received PGE 2 subsequently had a decreased requirement for oxytocin compared with the placebo group. Patients in the PGE 2 and oxytocin group had a significant decrease in the mean time to delivery compared with the placebo group Significantly, the lowest incidence of chorioamnionitis and endometritis was in the women who received PGE 2.

There also was a trend toward decreased frequency of cesarean delivery in the prostaglandin group. A subsequent report by Chua and coworkers 38 differed significantly from the findings of van der Walt and Venter, 35 Goeschen, 36 and Ray and Garite. Patients were assigned to treatment with oxytocin versus PGE 2 , administered in the form of two 3-mg vaginal pessaries, followed by oxytocin induction.

The mean cervical score was 3. The length of labor and incidence of operative delivery did not differ in the two groups. Interestingly, however, the experience with this investigation did not deter the authors from further use of PGE 2 in the same clinical setting. If patients did not begin labor within 12 hours, oxytocin was administered. Compared with women in the placebo group, those who received PGE 2 were less likely to require oxytocin at the end of the hour observation period 37 vs.

In addition, they had a significantly shorter interval from admission to onset of labor, a shorter latent period from ROM to onset of labor, and shorter interval from admission to delivery.

The overall incidence of maternal and neonatal infection was very low and did not differ significantly between the two groups. In the first phase of the investigation, patients received PGE 2 gel, 4 mg every 12 hours for two doses, and in the second phase, 3-mg PGE 2 vaginal suppositories, every 4—6 hours, for a maximum of three doses.

Patients not in labor after the maximum dose of prostaglandin received oxytocin. None developed chorioamnionitis or endometritis. Two-thirds of the cesareans were for failure to progress.

The largest and probably best designed trial of management for term patients with PROM level I evidence was published by Hannah and associates. The overall frequency of cesarean delivery was very low and did not differ among the four groups. Women in the expectant management oxytocin group had a significantly higher frequency of infection than women in the induction-with-oxytocin group — a finding consistent with previous reports. The rates of neonatal infection were comparably low in all groups, but neonates in the induction-with-oxytocin group were significantly less likely to receive antibiotics than those in the expectant management oxytocin or induction-with-prostaglandin group.

Women in the study expressed a greater preference for induction of labor than expectant management. Of note, four perinatal deaths occurred, all in the expectant management groups. Two of the deaths occurred in infants of women who were treated as outpatients.

In a subsequent investigation, Gafni and coworkers 42 assessed the economic impact of the four methods of management used in the aforementioned trial by Hannah and associates. Misoprostol, an analog of PGE 1 , has also been shown to be effective in inducing labor in patients with an unfavorable cervix, and it offers a marked cost savings compared with commercially available preparations of PGE 2.

Oxytocin was used to augment labor as needed in the misoprostol group. Patients in the misoprostol group required lower total doses of oxytocin, although there were no significant differences in time interval to delivery. Fewer patients in the misoprostol group required operative vaginal delivery 23 vs. There were no significant differences in the frequency of cesarean delivery or maternal and neonatal complications. On the basis of the information presented previously, there is consistent evidence from both level I and level II clinical trials to support the following plan of management algorithm outlined in Figure 3 grade of recommendation — A.

Algorithm for management of term patients with premature rupture of the membranes PROM. ROM, rupture of the membranes. Obstet Gynecol , Naeye RL: Factors that predispose to premature rupture of the fetal membranes. Am J Obstet Gynecol , Lenihan JP: Relationship of antepartum pelvic examinations to premature rupture of the membranes.

AmniSure placental alpha microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes.