Guidelines for Managing Prelabor Rupture of Membranes Based on ACOG's Recommendations

> 37 weeks

• If indicated (eg, by positive screening culture), prophylaxis for GBS

• Antibiotics for intra-amniotic infection

• Delivery

34 0/7–36 6/7 weeks

• Expectant management or delivery (induction or cesarean as indicated)

• Corticosteroids if not previously given and if delivery will occur in no less than 24 hours and not more than 7 days

• If indicated, screening and prophylaxis for GBS

• Antibiotics for intra-amniotic infection

24 0/7–33 6/7 weeks (preterm)

• Expectant management

• Corticosteroids

• Antibiotics to prolong latency

• If indicated, screening (swab for culture) and prophylaxis for GBS

• Antibiotics for intra-amniotic infection and delivery

• If < 32 weeks gestation, magnesium sulfate unless contraindicated

< 23–24 weeks (previable)

• Patient counseling; consideration of consultation with neonatologists and maternal–fetal medicine experts

• Expectant management or induction of labor

• As early as 20 6/7 weeks gestation, consideration of antibiotics

Not recommended before viability:

• Prophylaxis for GBS

• Corticosteroids

• Tocolysis

• Magnesium sulfate (for reducing risk of severe neurologic dysfunction)