title: Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers.
abstract: OBJECTIVE
  This study was undertaken to characterize variations in the management for women with preterm premature rupture of membranes (PPROM) among maternal-fetal medicine (MFM) specialists in the context of current recommendations for clinical practice and evidenced-based practice.
  
  
  METHODS
  We performed a Web-based survey of 1375 MFM providers. Participants were queried on practice characteristics and management issues including use of tocolytics, antibiotics, steroids, and timing of delivery.
  
  
  RESULTS
  A total of 508 providers (37%), representing all 50 states and 13 countries, responded to the survey. Only 30% reported a formal departmental protocol for managing women with PPROM. Consistent use of steroids (99.4%) and antibiotics (99.6%) were reported. Administration of steroids was confined to < or =32 weeks by 37%, and < or =34 weeks by 51% of practitioners. Repeated dosing of steroids was uncommon (16%). The antibiotics use and rationale for use varied among respondents. Tocolytics were used by 73% of respondents with magnesium sulfate the main agent used (98%). Use of tocolytics was generally used for 48 hours or less to attain steroid benefit (88%). Amniocentesis was used by 66% of practitioners in the acute evaluation of PPROM. Fetal lung maturity testing was reported by 78% with variability noted with respect to the test used. Outpatient management of women with PPROM after viability was noted by 43% of respondents. Gestational age at which expectant management is abandoned in women with PPROM varied significantly between respondents: > or =34 weeks by 56%, > pr =35 weeks by 26%, > or =36 weeks by 12%, and > or =37 weeks by 4.0%.
  
  
  CONCLUSIONS
  Although many management practices for women with PPROM are consistent with currently available evidence and practice recommendations, substantial variations still exist among MFM providers.
authors.affiliation: Department of Obstetrics and Gynecology, Center for Research in Women's Health, The University of Alabama at Birmingham, 619 19th Street, S-458 Old Hillman Building, Birmingham, AL 35249-7333, USA. ramsey_patrick@hotmail.com
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Ramsey
authors.forename: Francis S
authors.initials: FS
authors.lastname: Nuthalapaty
authors.forename: George
authors.initials: G
authors.lastname: Lu
authors.forename: Susan
authors.initials: S
authors.lastname: Ramin
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Nuthalapaty
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Ramin
mesh_terms: D019072:Antibiotic Prophylaxis; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000517:prevention & control / Q000628:therapy*; D005865:Gestational Age; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D015145:Tocolysis
chemical_list: D005938:Glucocorticoids