Premature rupture of membranes: many questions still unanswered

Management of premature rupture of membranes (PROM) still remains a subject of controversy among obstetricians. Although prompt delivery is generally recommended at term to reduce the risk of perinatal morbidity and mortality, some authors recommend expectant management especially in cases of poor Bishop's score to reduce caeserean delivery rate. Preterm PROM remote from term is even more challenging to obstetricians. Conservative management where possible should be pursued to reduce the risk of prematurity. Although available evidence supports the use of short-term antibioprophylaxis to reduce infectious morbidity and prolong the pregnancy, the choice of antibiotics still remains controversial. Current evidence indicates that antenatal corticosteroid in preterm PROM before term enhances neonatal outcome without increasing the risk of perinatal infection. Yet, there is no consensus as when to give steroids especially in the setting of black Africa where foetal lung maturation is now known to take place earlier than in the white race. The use of tocolysis has not been shown to be of any value in PROM, although some clinicians either practice prophylactic tocolysis or therapeutic tocolysis or both. Although neonatal outcome is improved by caeserean delivery especially in preterm babies with breech presentation, the route of delivery still remains a dilemma between obstetricians. Managementof PROM should be based on gestational age-based approach and individual assessment of the maternofoetal and neonatal risks should expeditious delivery or conservative management be pursued. Future research should be directed towards the determination of the choice of antibioprophylaxis in developing countries; the role of steroids in black Africa and the role of tocolytic agents and the mode of delivery in case of PROM before term needs to be evaluated. Clinics in Mother and Child Health Vol. 1(2) 2004: 115-12