Management of premature prelabor rupture of the membranes

Premature prelabor rupture of the fetal membranes affects about 3% of pregnancies. The cause is usually infection, especially at earlier gestations. The prognosis and the risks of delivery are both much worse at earlier gestations. Before viable pregnancy, termination may be offered. Once the fetus is viable, steroids to mature the fetal lungs and antibiotics to reduce infection are the mainstays of treatment. Delivery is recommended in the presence of signs of clear-cut infection at early gestational ages. At later ones, balancing the risks of infection from conservative treatment against the risk of prematurity from delivery is difficult. Published trials to date have not given clear guidance, but a number are ongoing.