Management of Preterm Labour
Pharmacological Management
- The American College of Obstetricians and Gynecologists strongly recommends antibiotics for pregnant individuals with PPROM at ≥24 0/7 weeks of gestation (GRADE 1B) 1, 3
- Antibiotics can be considered after PPROM at 20 0/7 to 23 6/7 weeks of gestation (GRADE 2C) 1, 4
- For previable PPROM at <20 weeks, shared decision-making is recommended regarding antibiotic use 5, 3
- The American College of Obstetricians and Gynecologists recommends antenatal corticosteroids between 24 and 34 weeks of gestation to accelerate fetal lung maturity, but not until the time when neonatal resuscitation and intensive care would be considered appropriate (GRADE 1B) 1, 2
- Magnesium sulfate is recommended for fetal neuroprotection when delivery is anticipated before 32 weeks, but not until the time when neonatal resuscitation would be appropriate (GRADE 1B) 1, 2
- Azithromycin can be used as an alternative to erythromycin when unavailable 6
- The American College of Obstetricians and Gynecologists recommends avoiding amoxicillin-clavulanic acid due to increased risk of necrotizing enterocolitis 6, 3
Management Based on Gestational Age
- The American College of Obstetricians and Gynecologists recommends offering both abortion care and expectant management options for previable PPROM (<20 weeks) (GRADE 1C) 1, 2
- For periviable PPROM (20-23 6/7 weeks), consider antibiotics to prolong latency (GRADE 2C) 1, 4
- The American College of Obstetricians and Gynecologists recommends administering antibiotics for PPROM at ≥24 weeks (GRADE 1B) 1, 3
- Consider antenatal corticosteroids and magnesium sulfate when appropriate 1, 2
- Avoid serial amnioinfusions and amniopatch (considered investigational) (GRADE 1B) 1, 4
Inpatient vs. Outpatient Management
- Initial observation in hospital is reasonable to ensure stability 5
- Outpatient management with close monitoring may be considered after stability is confirmed 5
- Monitor for signs of maternal complications such as hemorrhage or infection 5