Clinical Management Guidelines for Obstetrician–Gynecologists
NUMBER 217 (Replaces Practice Bulletin Number 188, January 2018)
Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics in collaboration with Robert Ehsanipoor, MD and Christian M. Pettker, MD.
本实践公告由美国妇产科医师学会实践公告委员会-产科，与医学博士Robert Ehsanipoor、医学博士Christian M. Pettker联合制定。
Prelabor Rupture of Membranes胎膜早破
Preterm birth occurs in approximately 10% of all births in the United States and is a major contributor to perinatal morbidity and mortality (1–3). Prelabor rupture of membranes (PROM) that occurs preterm complicates approximately 2–3% of all pregnancies in the United States, representing a significant proportion of preterm births, whereas term PROM occurs in approximately 8% of pregnancies (4–6). The optimal approach to assessment and treatment of women with term and preterm PROM remains challenging. Management decisions depend on gestational age and evaluation of the relative risks of delivery versus the risks (eg, infection, abruptio placentae, and umbilical cord accident) of expectant management when pregnancy is allowed to progress to a later gestational age. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research when available. Additional guidelines on the basis of consensus and expert opinion also are presented. This Practice Bulletin is updated to include information about diagnosis of PROM, expectant management of PROM at term, and timing of delivery for patients with preterm PROM between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation.
The definition of prelabor rupture of membranes is rupture of membranes before the onset of labor. Membrane rupture before labor that occurs before 37 weeks of gestation is referred to as “preterm prelabor rupture of membranes.”
Management of preterm and term PROM is influenced by gestational age and the presence of complicating factors such as clinical infection, abruptio placentae, labor, or abnormal fetal testing. An accurate assessment of gestational age and knowledge of the maternal, fetal, and neonatal risks are essential to appropriate evaluation, counseling, and care of patients with PROM.
The following recommendations are based on good and consistent scientific evidence (Level A):
< Patients with preterm PROM before 34 0/7 weeks of gestation should be managed expectantly if no maternal or fetal contraindications exist.
<A single course of corticosteroids is recommended for pregnant women between 24 0/7 weeks of gestation and 33 6/7 weeks of gestation and may be considered for pregnant women who are at risk of preterm birth within 7 days, including for those with ruptured membranes, as early as 23 0/7 weeks of gestation.
< A single course of corticosteroids is recommended for pregnant women between 34 0/7 weeks of gestation and 36 6/7 weeks of gestation at risk of preterm birth within 7 days and who have not received a previous course of antenatal corticosteroids if proceeding with induction or delivery in no less than 24 hours and no more than 7 days.