title: [Prenatal management of the risk of maternofetal infection in cases of PPROM].
abstract: Preterm premature rupture of membranes (PPROM) occurs in 3 % of pregnancies and is responsible for 30 % of premature births. The risks described in cases of PPROM are those of prematurity, acute maternal-fetal infection, cord prolapse, and abruptio placentae. The main objective of prenatal care is to reduce and anticipate the risk of perinatal infection and morbidity superimposed, but the predictive value of prenatal monitoring for the maternal-fetal infection prediction is low. Antibiotics are recommended routinely in PPROM cases. Tocolysis should not be continued more than 48h before 32 weeks gestation. Before 32 or 34 WG, a gain of 1 week of gestational age significantly reduces mortality and neonatal morbidity, and expectant management is usually preferred. French recommendations for clinical practice for expectant management or labor induction leave open either expectant management or labor induction after 34 WG. Between 34 and 37 weeks, the risk of rare severe morbidity related to prematurity are to be balanced against those of an acute infection or a maternal-fetal placental abruption. A large randomized trial comparing expectant and labor induction in cases of PPROM between 33 and 37 weeks showed no benefit of labor induction but did not have the power to explore rare and severe complications.
authors: Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 75012 Paris, France; Inserm U1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et biostatistique Sorbonne Paris Cité (CRESS), 75005 Paris, France. Electronic address: gilles.kayem@inserm.fr.
authors: G
authors: G
authors: Kayem
authors: Service de gynécologie-obstétrique, département hospitalo-universitaire « risques et grossesse », CHU Louis-Mourier, 178, avenue des Renouillers, 92700 Colombes, France.
authors: G
authors: G
authors: Girard
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D005865:Gestational Age; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007751:Labor, Induced; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D047928:Premature Birth / Q000517:prevention & control; D011295:Prenatal Care; D015149:Tocolytic Agents / Q000627:therapeutic use; D057832:Watchful Waiting
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D015149:Tocolytic Agents