The use of antenatal corticosteroids in the setting of PPROM was once considered controversial as the magnitude of the beneits was not as great as when the membranes were intact. A single course of corticosteroids, however, is now recommended for pregnant women with ruptured membranes between 24°/7 and 34°17 weeks' gestation (American College of Obstetricians and Gynecologists, 2017 a). As with periviability (p. 807), a single course of corticosteroids as early as 23°/7 weeks in those who are at risk for preterm delivery within 7 days may be considered (American College of Obstetricians and Gynecologists, 2017e). A similar controversy is found at the other end of the gestational age spectrum, wherein corticosteroid administration in the late-pre term period is also under consideration (p. 823).
Tissue sealants are used for various purposes in medicine, including achieving surgical hemostasis. As discussed in Chap. 18 (p. 351), there are limited reports of sealants in the repair of fetal membranes. Crowley and coworkers (2016) recently reviewed the available evidence and concluded that data are currently insuicient to evaluate sealing procedures for ruptured membranes. At Parkland Hospital, we do not currently use these agents for this indication.
Women with signs and symptoms of preterm labor with intact membranes are managed similarly to those with PPROM. If possible, delivery before 34 weeks' gestation is delayed. Drugs used to abate or suppress preterm uterine contractions are subsequently discussed.
• Amniocentesis to Detect Infection
Several tests have been used to diagnose intraamnionic infection (Andrews, 1995; Romero, 1993; Yoon, 1996). Although such infection can be conirmed with a positive test result, there is little utility for routine amniocentesis (American College of Obstetricians and Gynecologists (2017b).
Because glucocorticosteroids were found to accelerate lung maturation in preterm sheep fetuses, Liggins and Howie (1e972) evaluated them to treat women. Corticosteroid therapy was efective in lowering the incidence of RDS and neonatal initiation of betamethasone. Infants exposed to corticosteroids in these early studies have now been followed to age 31 years with no ill efects detected. In 1995, a National Institutes of ened preterm birth. In a subsequent meeting, another NIH
Conference (2000) concluded that data were insuicient to by hypertension, diabetes, multifetal gestation, fetal-growth restriction, or fetal hydrops. It was concluded, however, that it was reasonable to administer corticosteroids to these women.
A recent metaanalysis by Roberts and associates (20e17) of 30 studies totaling 7774 women and 8158 infants quantiied the beneit of a single course of corticosteroids. Treatment was associated with lower rates of perinatal death, neonatal death, RDS, intraventricular hemorrhage, necrotizing enterocolitis, need for mechanical ventilation, and systemic infection in the first 48 hours of life. No obvious beneits were gained for chronic lung disease, death in childhood, or neurodevelopmental delay in childhood. Therapy was not associated with chorioamnionitis. Parenthetically, corticosteroids given prophylactically to women at risk of preterm birth in low-and middle-income countries actually increase perinatal mortality rates (Althabe, 2015).