[Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Initial Management]

Abstract

Objective: To evaluate safety of home care, clinical and biological initial examination and effectiveness of prophylactic antibiotic in preventing maternal and neonatal infectious complications in women with term prelabor rupture of membranes.

Materials and methods: The MedLine database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.

Results: In case of expectant management and low rate of antibiotic prophylaxis coverage, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially when colonized with Group B Streptococcus (GBS) (LE3). Home care is therefore not recommended (Grade C). Studies investigating the initial clinical-biological examination are sparse. The initial examination should search for signs of intra-uterine infection. Repeated digital examination before and during labor is associated with an increased risk of intra-uterine infection (LE3). It is therefore recommended to limit the number of digital examinations before and during labor (Grade C). A GBS-positive vaginal swab is strongly associated with the risk of intra-uterine and neonatal infection (LE3) independently of the type management (induction vs. expectant management) and the mode of induction (oxytocin or prostaglandin) (LE3). When the GBS-positive vaginal swab has not been performed between 34 and 38 weeks, it is recommended to perform it on admission (Professional consensus). The diagnostic performance of the CRP and white blood cell count for the prediction of neonatal infection is low (LE3). If these tests are used, the negative predictive value of the CRP should be preferred (Professional consensus). In case of term prelabor rupture of membranes after 12hours, prophylactic antibiotics could reduce the rate of intra-uterine infection without reducing the risk of neonatal infection (LE3). Their use in term prelabor rupture of membranes after 12hours is therefore recommended (Grade C). When prophylactic antibiotics are indicated, intravenous beta-lactamine is the preferred option (Grade C).

Conclusion: Overall, the current data on initial management of term prelabor rupture of membranes are of low evidence level.

Keywords: Antibioprophylaxie; Infection intra-utérine; Intra-uterine infections; Management; Neonatal infection; Prise en charge; Prophylactic antibiotic; Rupture prématurée des membranes à terme; Term prelabor rupture of membranes; infection néonatale.