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OB/GYN
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Preterm Prelabor ROM
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Gestational age + presence of infection guide management.
Decision
Outcome
Decision
Confirmed ROM. Gestational age?
✓
<24 weeks → counsel about viability vs termination
✓
24 to <34 weeks
✓
34 to <37 weeks
Outcome
Counsel about expectant vs termination given high morbidity/mortality
Decision
24–<34 weeks — complicated?
✓
Infection or fetal/maternal compromise → delivery + intra-amniotic infection treatment (ampicillin + gentamicin) + corticosteroids + GBS prophylaxis
✓
Uncomplicated → expectant: latency abx (ampicillin + azithromycin → amoxicillin), antenatal corticosteroids, magnesium <32 wk for neuroprotection, fetal surveillance
Outcome
Delivery — typically vaginal unless obstetric indication for C-section
Outcome
Expectant management with latency antibiotics, steroids, magnesium <32 wk
No tocolytics — risk of infection.
Decision
34 to <37 weeks?
✓
Delivery + GBS prophylaxis (penicillin G) + corticosteroids if <34 wk
Outcome
Delivery — shared decision; GBS prophylaxis
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