Preterm premature rupture of membranes in the late preterm period: an argument against expectant management.

Preterm premature rupture of membranes, defined as the leaking of amniotic fluid through the cervical os before 37 weeks' gestation and before the onset of labor, complicates nearly 3% of deliveries and 30% of indicated late preterm deliveries. The current management of preterm premature rupture of membranes that occurs between 34 to 36 weeks' gestation has pivoted from recommending delivery to recommending either delivery or expectant management because of a large trial that evaluated these management strategies. The potential neonatal benefits of expectant management (reducing complications of prematurity) must be weighed against the maternal risks (and therefore the attached neonatal risks) of prolonging the gestation under close surveillance. We recommend immediate delivery for preterm premature rupture of membranes that occurs at 34 weeks of gestation or later given the higher risk for maternal complications, specifically hemorrhage and infection, associated with expectant management. Furthermore, limited evidence exists to prove that immediate delivery has increased risks for adverse neonatal outcomes, including sepsis or composite neonatal morbidity, when compared with expectant management.