[Prenatal management of the risk of maternofetal infection in cases of PPROM]

Abstract

Preterm premature rupture of membranes (PPROM) occurs in 3 % of pregnancies and is responsible for 30 % of premature births. The risks described in cases of PPROM are those of prematurity, acute maternal-fetal infection, cord prolapse, and abruptio placentae. The main objective of prenatal care is to reduce and anticipate the risk of perinatal infection and morbidity superimposed, but the predictive value of prenatal monitoring for the maternal-fetal infection prediction is low. Antibiotics are recommended routinely in PPROM cases. Tocolysis should not be continued more than 48h before 32 weeks gestation. Before 32 or 34 WG, a gain of 1 week of gestational age significantly reduces mortality and neonatal morbidity, and expectant management is usually preferred. French recommendations for clinical practice for expectant management or labor induction leave open either expectant management or labor induction after 34 WG. Between 34 and 37 weeks, the risk of rare severe morbidity related to prematurity are to be balanced against those of an acute infection or a maternal-fetal placental abruption. A large randomized trial comparing expectant and labor induction in cases of PPROM between 33 and 37 weeks showed no benefit of labor induction but did not have the power to explore rare and severe complications.