How Swedish obstetricians manage premature rupture of the membranes in preterm gestations.

Fifty-two of 53 obstetric departments in Sweden answered a questionnaire concerning preterm premature rupture of membranes. The answers formed the basis for a consensus conference and a symposium, which resulted in the following recommendations. The pregnancy should be interrupted when preterm premature rupture of membranes occurs before week 20 of gestation; individualized management is needed for preterm premature rupture of membranes between 20 and 25 weeks. After 25 weeks, institute hospitalization and bed rest, with a body temperature check twice a day, electronic fetal heart rate monitoring daily, and ultrasonography every second week. Cervical and urethral flora should be cultured once a week. Antibiotic infusion and prompt delivery should be instituted if an intrauterine infection occurs, and tocolysis is called for in cases of preterm labor in which intrauterine infection and abruptio placentae can be excluded. Labor should be induced between 32 and 34 weeks' gestation if spontaneous contractions do not occur. Cesarean section should be considered in cases of breech presentation earlier than 34 weeks, with delivery in a hospital with a neonatal intensive care unit if before 32 weeks' gestation.