Expectant management of premature prelabour rupture of membranes 34-36+6 weeks: a return to midwifery-led care

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RCOG guidance states that women whose membranes have ruptured should be offered immediate delivery after 34 complete weeks’ gestation. A recent Cochrane review (Bond et al 2017) found there was no difference in the level of neonatal sepsis between women who underwent expectant management or immediate birth following premature pre-labour rupture of membranes (PPROM) before 37 weeks, but that there was an increase in negative neonatal outcome measures, including respiratory distress syndrome (RDS), neonatal unit admission and lower gestational age. This is an update to an earlier review (Bond et al 2017), and includes five new randomised controlled trials, representing 2927 additional women. These include the PPROMT trial (Morris et al 2016) and the PPROMEXIL trial (van der Ham et al 2012a, 2012b). These trials found evidence that there was no difference in primary neonatal outcomes, including neonatal sepsis, between immediate delivery and expectant management of PPROM at 34+0-36+6 weeks’ gestation. This paper examines the evidence and discusses the benefits of a move towards expectant management and midwifery-led care for women with PPROM at 34+0-36+6 weeks’ gestation.

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