Table 4.

MOGGE take home message: Treat

At 37 weeks of gestation or beyond:

• Delivery should be expedited.

• Antibiotics may be given to treat GBS if positive, or if IAI is clinically suspected. Digital pelvic examination should be minimized. Administration of prophylactic antibiotics is controversial; it may be considered if latency is longer than 12 hours

• Induction of labor via IV oxytocin seems to be superior to other options

• If Cesarean delivery is indicated, vaginal irrigation with povidone-iodine 1% is recommended to reduce the risk of endometritis and wound complications

34 0/7 to 36 6/7 weeks of gestation:

• Gestational age at delivery should be determined by local neonatal data. Expectant management may be planned up to 37 weeks of gestation if significantly unfavorable neonatal outcomes are anticipated with preterm labor

• Administration of antenatal steroids is recommended if not administered earlier in pregnancy

• Antibiotics can be given to treat GBS if positive or unknown. Latency antibiotics are also reasonable if expectant management is elicited

Less than 34 weeks of gestation:

• Hospitalization is the standard of care. Home care should not be offered as an alternative

• GBS swab should be obtained for culture

• During hospital stay, monitoring of fetal heart rate, uterine contractions, and clinical signs of IAI and placental abruption should be considered

• A single course of corticosteroids should be given for enhancement of lung maturity

• Magnesium sulfate is administered to reduce the risk of cerebral palsy if labor is pending prior to 32 weeks of gestation

• Antibiotics can be given for GBS prophylaxis) if labor is pending and GBS status is either positive or unknown

• Latency antibiotics should be given to prolong pregnancy and reduce the risk of neonatal morbidity

• Expectant management is reasonable up to 34 weeks of gestation. Further expectant management should be justified by consensus between obstetric and neonatology team based on their local data

• Immediate delivery is indicated in the presence of non-reassuring fetal status, clinical evidence of infection, or significant placenta abruption

Pre-viable PROM:

• Expectant management is not the standard of care. Hospitalization is not medically necessary

• A discussion should be conducted with the patient to allow a shared decision based on realistic expectations

• If expectant management is elicited, administration of latency antibiotics may be considered

• Administration of magnesium sulfate or antenatal steroids is not indicated

• Hospitalization is considered if pregnancy reaches gestational age of viability

MOGGE – Middle-East OBGYN Graduate Education. PROM – prelabor rupture of membranes, GBS – Group B streptococci, IAI – intra-amoniotic infection