An evidence-based approach to the evaluation and treatment of premature rupture of membranes: Part II.
Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is responsible for one third of all preterm births. In part I of this series, the definition, pathophysiology, and diagnosis of PPROM was reviewed. In this part, treatment is discussed. Adjunctive antibiotic and corticosteroid therapy has the strongest evidence for improving neonatal outcome. Treatment is gestational age-dependent and will be influenced by local neonatal intensive-care unit (NICU) survival statistics. This review presents the available evidence and grades it according to the U.S. Preventative Task Force recommendations.


OBJECTIVE
After completion of this article, the reader should be able to summarize the data on the use of labor inhibition in the setting of PPROM, list potential antibiotics regimens that are recommended for prophylaxis in patients with PPROM, to describe the benefits of corticosteroid administration in patients with PPROM, and to outline potential management strategies for patients with PPROM based on gestational age.
Magee Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. tcanavan@mail.magee.edu
Timothy P
TP
Canavan
Hyagriv N
HN
Simhan
Steve
S
Caritis
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D005323:Fetal Monitoring; D005865:Gestational Age; D006801:Humans; D008168:Lung / Q000196:embryology; D011247:Pregnancy; D015149:Tocolytic Agents / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D015149:Tocolytic Agents