Preterm delivery due to
preterm labor and
pPROM is responsible for most infant morbidity and mortality in the United States. The patient who presents with suspicious symptoms should undergo a thorough evaluation to confirm the diagnosis of either entity and identify a treatable cause. Determination of gestational age, fetal well-being, and the presence of intrauterine
infection is a crucial step in subsequent management.
Corticosteroid therapy has been demonstrated to be one of the most effective antenatal interventions to reduce infant morbidity and should be administered to patients with
preterm labor, if feasible, when fetal pulmonary maturity is absent or undocumented. We recommend a similar protocol regarding gravidas with
pPROM remote from term but recognize the need for further study in this area. Acute
tocolytic therapy has been demonstrated to offer short-term benefit to enhance
corticosteroid effect. However, all of the available
tocolytic agents carry significant risks to the mother and fetus. As such, administration of these agents should be given only when the potential benefits outweigh the risks of administration. Evaluation for fetal pulmonary maturity and intrauterine
infection, in concert with evaluation of gestational age-dependent risks of prematurity, may be helpful in determining whether
tocolysis should be attempted. Adjunctive
antibiotic administration has not been shown to reduce maternal or infant morbidity in the face of
preterm labor. However, such treatment offers a reduction of
chorioamnionitis, prolongation of latency, and a possible reduction of neonatal infectious and gestational age-dependent morbidity in the setting of
pPROM remote from term. Finally, current guidelines recommend the administration of intrapartum GBS prophylaxis when
preterm birth or prolonged membrane
rupture is anticipated if GBS carrier status is unknown or positive. Intrapartum treatment with intravenous
penicillin or
ampicillin is appropriate.