Preterm prelabor rupture of membranes (PPROM) is associated with significant neonatal risks. When PPROM occurs during the late preterm period (between 34 0/7 and 36 6/7 weeks gestation), the optimal gestational age for delivery is unclear and varies by regional practice. In 2020 the American College of Obstetrician and Gynecologists (ACOG) published guidelines indicating that both expectant management and immediate delivery were considered reasonable options. Historically, studies that examined the topic of expectant management versus immediate delivery of PPROM after 34 weeks supported immediate delivery based on an observed increased risk of infectious complications without any benefit to neonatal outcome. However, these studies were small and were underpowered to detect a meaningful difference in neonatal outcomes. In this review, we examine six randomized controlled trials and two meta-analyses of randomized controlled trials that investigated neonatal and maternal outcomes of expectant management versus immediate delivery of late preterm PROM. Included in this analysis are three recent randomized controlled trials (PPROMEXIL, PPROMEXIL2, and PPROMT) and two meta-analyses that demonstrate a decreased risk of respiratory distress syndrome and NICU admission rate with expectant management. This is counterbalanced by an increased risk of chorioamnionitis with expectant management, but definitions of chorioamnionitis are variable in the trials with unclear generalizability of the outcome across the trials. Additional analysis with a childhood outcome study showed no significant difference in neurodevelopment in infants born to expectant management of late preterm PROM, and an economic analysis found that expectant management was associated with lower delivery and neonatal costs. Overall, we support expectant management of late preterm PROM if maternal and fetal status are stable and there are no contraindications to expectant management but not extending beyond 37 0/7 weeks gestation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ajogmf.2024.101563 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Fetal-to-Neonatal Transition of an Infant with Transposition of the Great Arteries and Intact Ventricular Septum: A Case Report.
Biomed Hub
December 2024
Division of Paediatric Cardiology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre (LUMC), Leiden, The Netherlands.
Introduction: Transposition of the great arteries (TGA), especially with intact ventricular septum (TGA-IVS), presents unique challenges during fetal-to-neonatal transition, which can contribute to developing persistent pulmonary hypertension of the newborn (PPHN).
Case Presentation: A male newborn with TGA-IVS, delivered via caesarean section, presented with hypoxemia and tachycardia immediately after birth (preductal SpO: 50-60%, post-ductal SpO: 70-75%). Echocardiography revealed a floppy interatrial septum and two interatrial connections with bidirectional shunting.
Evaluating the effect of a virtual reality digital therapeutic on maternal stress among expectant and postpartum Black and Latina mothers: a protocol paper.
Front Psychiatry
December 2024
Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, FL, United States.
Background: Maternal mental health is vital to overall well-being, particularly among expectant and postpartum Black and Latina women who experience higher stress levels and mental health challenges. Traditional healthcare systems often fail to meet these needs, underscoring the need for innovative and accessible interventions. NurtureVR, a digital maternal mental health and educational program, leverages virtual reality to offer mindfulness, relaxation, and guided imagery to support these women.
View Article and Find Full Text PDFSociety of Family Planning Clinical Recommendation: Medication management for early pregnancy loss.
Contraception
December 2024
Planned Parenthood South Atlantic, Raleigh, NC, USA and McLeod Regional Medical Center, Florence, SC, USA; University of Washington Department of Obstetrics and Gynecology, 1959 NE Pacific St, Box 356460, Seattle, WA 98005, USA; Pegasus Health Justice Center, Dallas, TX, 75207, USA; Washington University, St. Louis, MO, USA.
Early pregnancy loss (EPL), also known as miscarriage or spontaneous abortion, makes up 15-20% of all clinically recognized pregnancies. EPL is a broad term that includes intrauterine pregnancies (IUPs) with findings that suggest the pregnancy may not progress or definitely will not progress; pregnancies with a gestational sac (GS) in the lower endometrial cavity or endocervical canal in the process of expulsion; residual pregnancy tissue or persistent GS; and complete passage of the GS without residual tissue. This document addresses medication management of EPL in which the complete passage of the GS has not yet occurred, including pregnancies concerning for and diagnostic of EPL (sometimes called "missed abortion") and EPL in progress.
View Article and Find Full Text PDFNavigating management of localized prostate cancer in the geriatric population.
Crit Rev Oncol Hematol
December 2024
The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA; Warren Alpert Medical School of Brown University, Providence, RI, USA. Electronic address:
Prostate cancer (PCa) is highly prevalent among aging men and a significant contributor to global mortality. Balancing early detection and treatment of "clinically significant" disease with avoiding over-detection and overtreatment of slow-growing tumors is challenging, especially for elderly patients with competing health risks and potentially aggressive disease phenotypes. This review emphasizes the importance of individualized approaches for diagnosing and treating PCa in geriatric patients.
View Article and Find Full Text PDFMaternal Characteristics and Pregnancy Outcomes Associated with Delivery versus Expectant Management following Decreased Fetal Movement at Term.
Am J Perinatol
December 2024
Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
Objective: This study aimed to compare maternal characteristics and pregnancy outcomes between term patients evaluated for decreased fetal movement (DFM) who were delivered versus expectantly managed.
Study Design: Retrospective cohort study of term patients delivering within a large hospital system from 2015 to 2023 who were evaluated for DFM. Patients were classified into three groups based on the time between evaluation for DFM and delivery admission: (1) <24 hours, (2) 24-48 hours, (3) >48 hours.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!