Expectant Management Beyond 34 Weeks' Gestation Should Be Offered for Preterm Premature Rupture of Membranes

Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remain mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the nationally published guidelines, and discuss our opinion on the controversy as well as future directions for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34 weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and, worse, if not universally offered in the absence of contraindications to expectant management, may be an area of inequitable or biased care. · Recent studies have characterized outcomes with expectant management of PPROM after 34 weeks.. · There remains controversy regarding delivery timing for pregnancies complicated by PPROM.. · Expectant management should be routinely offered for PPROM in the absence of contraindications..