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summarizing the high points, talking about changes in clinical guidelines and what has changed from before. Talk about evidence and clinical consensus. I also have to come up with some questions to lead the conversation with. Document Preview: 918 VOL. 122, NO. 4, OCTOBER 2013 OBSTETRICS & GYNECOLOGY Background The definition of PROM is rupture of membranes before the onset of labor. Membrane rupture before labor and before 37 weeks of gestation is referred to as preterm PROM. Management is influenced by gestational age and the presence of complicating factors, such as clinical infection, abruptio placentae, labor, or nonreasurring fetal status.

summarizing the high points, talking about changes in clinical guidelines and what has changed from before. Talk about evidence and clinical consensus. I also have to come up with some questions to lead the conversation with. Document Preview:
918 VOL. 122, NO. 4, OCTOBER 2013 OBSTETRICS & GYNECOLOGY Background The definition of PROM is rupture of membranes before the onset of labor. Membrane rupture before labor and before 37 weeks of gestation is referred to as preterm PROM. Management is influenced by gestational age and the presence of complicating factors, such as clinical infection, abruptio placentae, labor, or nonreasurring fetal status. An accurate assessment of gestational age and knowledge of the maternal, fetal, and neonatal risks are essential to appropriate evaluation, counseling, and care of patients with PROM. Etiology of Premature Rupture of Membranes Membrane rupture may occur for a variety of reasons. Although membrane rupture at term can result from a normal physiologic weakening of the membranes combined with shearing forces created by uterine contractions, preterm PROM can result from a wide array of pathologic mechanisms that act individually or in concert (4, 5). Intraamniotic infection has been shown to be commonly associated with preterm PROM, especially at earlier gestational ages (6). A history of preterm PROM is a major risk factor for preterm PROM or preterm labor in a subsequent pregnancy (7, 8). Additional risk factors associated with preterm PROM are similar to those associated with spontaneous preterm birth and include short cervical length, second-trimester and third-trimester bleeding, low body mass index, low socioeconomic status, cigarette smoking, and illicit drug use (9–12). Although each of these risk factors is associated with preterm PROM, it often occurs in the absence of recognized risk factors or an obvious cause. Term Premature Rupture of Membranes At term, PROM complicates approximately 8% of pregnancies and generally is followed by the prompt onset of spontaneous labor and delivery. In a large randomized trial, one half of women with PROM who were managed expectantly gave birth within 5 hours and 95% gave birth within 28 hours of membrane rupture (13).

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