[Modalities of birth in case of uncomplicated preterm premature rupture of membranes: CNGOF Preterm Premature Rupture of Membranes Guidelines]

Abstract

Objective: To identify the ideal gestational age at delivery for preterm premature rupture of membranes and modalities of birth.

Method: To identify studies, research was conducted using Pub-Med, Embase and Cochrane databases.

Results: Prolonged latency duration after pPROM does not worsen neonatal prognosis (NP3). Therefore, it is recommended not to deliver before 34 weeks of gestation for patient with uncomplicated preterm rupture of membranes (pPROM) (Grade C). After 34 weeks of gestation, expectant management for pPROM is not associated with neonatal sepsis (NP1) but is associated to intra-uterine infection (NP2). Early delivery is associated with higher risk of respiratory distress syndrome (NP2), higher risk of cesarean section (NP2) and longer duration of NICU hospitalization (NP2). Before 37 weeks of gestation, expectant management is recommended for uncomplicated pPROM (Grade A), even if vaginal group B streptococcus is positive, as long as antibiotics are used at the time of membranes rupture (Professional consensus). Elective cesarean section is reserved for usual obstetrical indications. Oxytocin and prostaglandins are reasonable options for inducing labor (Professional consensus). Data are too scarce to establish recommendation regarding intra-cervical balloons in case of pPROM (Professional consensus).

Conclusion: Expectant management is recommended for uncomplicated pPROM before 37 weeks of gestation.

Keywords: Ballon; Balloon; Déclenchement; Group B streptococcus; Induction; Infection; Latence; Latency period; Mechanical ripening; Prematurity; Preterm premature rupture of membranes; Prostaglandin; Prostaglandines; Prématurité tardive; Rupture prématurée des membranes; Streptocoque B.