A22-year-old G3P1102 is admitted to the Labor and Delivery ward at 28 weeks' gestation complaining of watery vaginal discharge. You confirm the diagnosis of preterm premature rupture of amniotic membranes (PPROM). Fetal monitoring demonstrates reassuring fetal heart tones and no contractions are noted. The patient is understandably concerned and asks you why this happened and what this means for her pregnancy. Which of the following should you tell her? Which of the following is the most appropriate therapy for this woman?
- begin antibiotic therapy to prolong the latency period until labor begins
- immediate cesarean delivery to prevent umbilical cord prolapse
- induction of labor to prevent intraamniotic infection
- amniocentesis to determine fetal lung maturity status
- placement of a cervical cerclage to prevent preterm delivery
Answer(s): A
Explanation:
Multiple randomized-controlled trials have now demonstrated the benefit of administering antibiotics to women with PPROM at less than 32 weeks' gestation. Most importantly, these drugs prolong the latent period until labor begins, but reductions have also been noted inmaternal infection, fetal infection, fetal respiratory distress syndrome, and fetal intraventricular hemorrhage. Commonly used antibiotics are ampicillin and erythromycin, but efficacy has been noted with many different regimens. Cesarean delivery at this point is not indicated, but might need to be performed in case of nonreassuring fetal status or malpresentation (e.g., breech). Induction of labor generally takes place between 32 and 34 weeks if the patient's status remains stable, or sooner in the event of amniotic infection or other concerns.
Amniocentesis may be performed to look for evidence of amniotic infection, but the likelihood of fetal lung maturity at this point is remote. Patients with previously placed cervical cerclages may be candidates for expectant management with the cerclage in place, but it would be inappropriate to place a cerclage after PPROM.