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Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers.

Abstract：

OBJECTIVE:This study was undertaken to characterize variations in the management for women with preterm premature rupture of membranes (PPROM) among maternal-fetal medicine (MFM) specialists in the context of current recommendations for clinical practice and evidenced-based practice. STUDY DESIGN:We performed a Web-based survey of 1375 MFM providers. Participants were queried on practice characteristics and management issues including use of tocolytics, antibiotics, steroids, and timing of delivery. RESULTS:A total of 508 providers (37%), representing all 50 states and 13 countries, responded to the survey. Only 30% reported a formal departmental protocol for managing women with PPROM. Consistent use of steroids (99.4%) and antibiotics (99.6%) were reported. Administration of steroids was confined to < or =32 weeks by 37%, and < or =34 weeks by 51% of practitioners. Repeated dosing of steroids was uncommon (16%). The antibiotics use and rationale for use varied among respondents. Tocolytics were used by 73% of respondents with magnesium sulfate the main agent used (98%). Use of tocolytics was generally used for 48 hours or less to attain steroid benefit (88%). Amniocentesis was used by 66% of practitioners in the acute evaluation of PPROM. Fetal lung maturity testing was reported by 78% with variability noted with respect to the test used. Outpatient management of women with PPROM after viability was noted by 43% of respondents. Gestational age at which expectant management is abandoned in women with PPROM varied significantly between respondents: > or =34 weeks by 56%, > pr =35 weeks by 26%, > or =36 weeks by 12%, and > or =37 weeks by 4.0%. CONCLUSION:Although many management practices for women with PPROM are consistent with currently available evidence and practice recommendations, substantial variations still exist among MFM providers.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Ramsey PS,Nuthalapaty FS,Lu G,Ramin S,Nuthalapaty ES,Ramin KD

doi

10.1016/j.ajog.2004.08.005

subject

Has Abstract

pub_date

2004-10-01 00:00:00

pages

1497-502

issue

eissn

0002-9378

issn

1097-6868

pii

S0002937804008695

journal_volume

191

pub_type

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Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers.