Management of premature rupture of the fetal membranes at term
- William E Scorza, MD
William E Scorza, MD
- Chief of Obstetrics and Gynecology
- Division of Maternal Fetal Medicine
- Lehigh Valley Physician Group
Premature rupture of the membranes (PROM) refers to rupture of the fetal membranes prior to the onset of regular uterine contractions. It may occur at term (≥37 weeks of gestation) or preterm (<37 weeks of gestation); the latter is designated preterm PROM (PPROM). Midtrimester PROM typically refers to PPROM at 16 to 26 weeks of gestation; this is an arbitrary definition, which varies slightly among investigators. The frequencies of term, preterm, and midtrimester PROM are approximately 8, 3, and less than 1 percent of pregnancies, respectively.
Management of PROM depends upon several factors, most importantly the gestational age at occurrence and the maternal-fetal clinical condition. The management of PROM at term will be reviewed here. Issues regarding midtrimester PROM and management of PPROM are discussed separately. (See "Midtrimester preterm premature rupture of membranes" and "Preterm premature (prelabor) rupture of membranes".)
We believe women with term premature rupture of the membranes (PROM) should be evaluated by a clinician. Whether the patient should be evaluated immediately or can remain at home for a few hours to see if labor begins has not been studied. In the absence of high-quality data supporting the safety of delaying evaluation, the most prudent approach is prompt assessment to confirm membrane rupture, exclude the presence of infection or a nonreassuring fetal heart rate pattern, determine fetal position, evaluate maternal and fetal well-being, and discuss options for further management.
●The diagnosis of PROM is based upon a characteristic history (ie, leaking fluid per vagina) and speculum examination (ie, visualization of fluid flowing from the cervical os), supplemented by diagnostic testing of fluid in the posterior fornix, if the diagnosis is uncertain. The clinical manifestations and diagnosis of PROM are the same across gestation and are discussed in detail separately. Digital cervicovaginal examination should be avoided, as it has been associated with an increased risk of intrauterine infection. (See "Preterm premature (prelabor) rupture of membranes", section on 'Diagnosis'.)
●Gestational age is determined according to the usual parameters (last menstrual period and/or ultrasound biometry). (See "Prenatal assessment of gestational age and estimated date of delivery".)
- Dare MR, Middleton P, Crowther CA, et al. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev 2006; :CD005302.
- Mozurkewich EL, Wolf FM. Premature rupture of membranes at term: a meta-analysis of three management schemes. Obstet Gynecol 1997; 89:1035.
- Hannah ME, Ohlsson A, Farine D, et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. TERMPROM Study Group. N Engl J Med 1996; 334:1005.
- Tran SH, Cheng YW, Kaimal AJ, Caughey AB. Length of rupture of membranes in the setting of premature rupture of membranes at term and infectious maternal morbidity. Am J Obstet Gynecol 2008; 198:700.e1.
- Herbst A, Källén K. Time between membrane rupture and delivery and septicemia in term neonates. Obstet Gynecol 2007; 110:612.
- Gafni A, Goeree R, Myhr TL, et al. Induction of labour versus expectant management for prelabour rupture of the membranes at term: an economic evaluation. TERMPROM Study Group. Term Prelabour Rupture of the Membranes. CMAJ 1997; 157:1519.
- Tan BP, Hannah ME. Prostaglandins versus oxytocin for prelabour rupture of membranes at term. Cochrane Database Syst Rev 2000; :CD000159.
- Lin MG, Nuthalapaty FS, Carver AR, et al. Misoprostol for labor induction in women with term premature rupture of membranes: a meta-analysis. Obstet Gynecol 2005; 106:593.
- Hofmeyr GJ, Gülmezoglu AM, Pileggi C. Vaginal misoprostol for cervical ripening and induction of labour. Cochrane Database Syst Rev 2010; :CD000941.
- Crane JM, Young DC. Induction of labour with a favourable cervix and/or pre-labour rupture of membranes. Best Pract Res Clin Obstet Gynaecol 2003; 17:795.
- Thomas J, Fairclough A, Kavanagh J, Kelly AJ. Vaginal prostaglandin (PGE2 and PGF2a) for induction of labour at term. Cochrane Database Syst Rev 2014; :CD003101.
- Zeteroğlu S, Engin-Ustün Y, Ustün Y, et al. A prospective randomized study comparing misoprostol and oxytocin for premature rupture of membranes at term. J Matern Fetal Neonatal Med 2006; 19:283.
- ACOG Committee on Practice Bulletins -- Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114:386. Reaffirmed February 2017.
- Güngördük K, Asicioglu O, Besimoglu B, et al. Labor induction in term premature rupture of membranes: comparison between oxytocin and dinoprostone followed 6 hours later by oxytocin. Am J Obstet Gynecol 2012; 206:60.e1.
- McMaster K, Sanchez-Ramos L, Kaunitz AM. Evaluation of a Transcervical Foley Catheter as a Source of Infection: A Systematic Review and Meta-analysis. Obstet Gynecol 2015; 126:539.
- Wolff K, Swahn ML, Westgren M. Balloon catheter for induction of labor in nulliparous women with prelabor rupture of the membranes at term. A preliminary report. Gynecol Obstet Invest 1998; 46:1.
- Cabrera IB, Quiñones JN, Durie D, et al. Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes. J Matern Fetal Neonatal Med 2016; 29:967.
- Mackeen AD, Walker L, Ruhstaller K, et al. Foley catheter vs prostaglandin as ripening agent in pregnant women with premature rupture of membranes. J Am Osteopath Assoc 2014; 114:686.
- Keirse MJ, Ottervanger HP, Smit W. Controversies: prelabor rupture of the membranes at term: the case for expectant management. J Perinat Med 1996; 24:563.
- Seaward PG, Hannah ME, Myhr TL, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol 1997; 177:1024.
- Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991; 164:859.
- Seaward PG, Hannah ME, Myhr TL, et al. International multicenter term PROM study: evaluation of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Premature Rupture of the Membranes. Am J Obstet Gynecol 1998; 179:635.
- Hannah ME, Hodnett ED, Willan A, et al. Prelabor rupture of the membranes at term: expectant management at home or in hospital? The TermPROM Study Group. Obstet Gynecol 2000; 96:533.
- Ellestad SC, Swamy GK, Sinclair T, et al. Preterm premature rupture of membrane management--inpatient versus outpatient: a retrospective review. Am J Perinatol 2008; 25:69.
- Bartfield MC, Carlan SJ. The home management of preterm premature ruptured membranes. Clin Obstet Gynecol 1998; 41:503.
- Saccone G, Berghella V. Antibiotic prophylaxis for term or near-term premature rupture of membranes: metaanalysis of randomized trials. Am J Obstet Gynecol 2015; 212:627.e1.
- Wojcieszek AM, Stock OM, Flenady V. Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev 2014; :CD001807.
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Term Prelabour Rupture of Membranes (Term PROM) C-Obs 36. March 2014.
- http://sogc.org/wp-content/uploads/2013/09/October2013-CPG298-ENG-Online_Final.pdf (Accessed on April 17, 2014).
- Hannah ME, Ohlsson A, Wang EE, et al. Maternal colonization with group B Streptococcus and prelabor rupture of membranes at term: the role of induction of labor. TermPROM Study Group. Am J Obstet Gynecol 1997; 177:780.
- INITIAL EVALUATION
- ACTIVE OR EXPECTANT MANAGEMENT?
- Cost analysis
- MANAGEMENT OF INDUCTION
- EXPECTANT MANAGEMENT
- Duration of expectant management
- Meconium stained amniotic fluid
- Expectant management in hospital or at home?
- Antibiotic prophylaxis
- Group B streptococcus colonization
- Maternal and fetal monitoring
- MANAGEMENT OF THE NEWBORN
- SUMMARY AND RECOMMENDATIONS