Preterm Labor Management Guidelines

Diagnosis and Initial Assessment

The American College of Obstetricians and Gynecologists (ACOG) recommends initial assessment to include evaluation for signs of infection, placental abruption, and fetal well-being 2
Fetal biometry, amniotic fluid volume assessment, and fetal Doppler waveform analysis should be performed at first diagnosis of preterm complications 3

The American College of Obstetricians and Gynecologists (ACOG) recommends individualized counseling about maternal and fetal risks for patients with preterm prelabor rupture of membranes (PPROM), offering both abortion care and expectant management options depending on gestational age and clinical circumstances 1, 2
All patients with previable PPROM (<20 weeks) should be offered abortion care due to high maternal risks and poor fetal outcomes 1, 4
Antibiotics can be considered to prolong latency (GRADE 2C) in periviable PPROM (20-23 6/7 weeks) 5, 4
Antibiotics are strongly recommended (GRADE 1B) for PPROM at ≥24 weeks 5, 4
Antenatal corticosteroids should be administered between 24+0 and 34+0 weeks gestation 3

A 7-day course of antibiotic therapy with IV ampicillin and erythromycin for 48 hours followed by oral amoxicillin and erythromycin for 5 days is recommended 4
Azithromycin can replace erythromycin if unavailable 4
Avoid amoxicillin-clavulanic acid due to increased risk of necrotizing enterocolitis 4
Magnesium sulfate is recommended for fetal neuroprotection when delivery is anticipated before 32 weeks 3

Cerclage management with PPROM should be similar to PPROM at later gestational ages, with reasonable options to either remove cerclage or leave it in situ after discussing risks and benefits 4, 2
Serial amnioinfusions and amniopatch are considered investigational and should only be used in clinical trial settings 2
Serial amnioinfusions and amniopatch are not recommended for routine care of previable and periviable PPROM (GRADE 1B) 4

Outpatient management should include monitoring for signs of infection, including daily temperature checks 2
Weekly outpatient visits are recommended for assessment of maternal vital signs, fetal heart rate, physical examination, and possible laboratory evaluation 2
Hospital readmission is indicated for hemorrhage, infection, fetal demise, or when reaching viability for administration of antenatal corticosteroids and magnesium sulfate 2

Using amoxicillin-clavulanic acid, which increases risk of necrotizing enterocolitis 4