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.
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Behavioral change often lags behind science.
“Behavioral change often lags behind science [57].”
From Lack of evidence for prescription of antepartum bed rest (2011) · cites this paper as [57]
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BackgroundRecommendations of activity restriction in high-risk pregnancy scenarios: a Danish national survey
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- Authors
- Ramsey, P. S., Nuthalapaty, F. S., Lu, G., Ramin, S., Nuthalapaty, E. S., & Ramin, K. D.
- Affiliations
- University of Alabama at Birmingham (US)
- The University of Texas Health Science Center at Houston (US)
- University of Minnesota (US)
- Corresponding author
- Ramsey, Patrick S.
- ORCID
- Ramsey, Patrick S.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2004-10
- Volume
- 191
- Issue
- 4
- Pages
- 1497-1502
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W2109050579
- Cited by
- 81
- References
- 19
- Citations by year
- 2026: 1 · 2024: 1 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 3 · 2014: 6 · 2013: 2 · 2012: 6
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD001402, K12 HD 01402)
- Topics
- Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- preterm premature rupture of membranes, clinical practice variation, tocolytic agents, magnesium sulfate, corticosteroids, antibiotics, expectant management, timing of delivery, amniocentesis, clinical practice guidelines adherence
- MeSH terms
- Female, Premature Rupture of Fetal Membranes, Fetal Membranes, Premature Rupture, Gestational Age, Glucocorticoids, Humans, Male, Practice Patterns, Physicians', Pregnancy, Tocolysis, Antibiotic Prophylaxis
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