Tocolytic therapy in preterm PROM

Preterm premature rupture of the membranes nearly always leads to preterm labor and delivery. Preterm delivery accounts for most of the morbidity attributable to PPROM. Antibiotic and corticosteroid treatment may modify the outcome of pregnancy after PPROM. The extent of morbidities attributable to PPROM also justifies consideration of the use of tocolysis, at least for a limited period of time (48 hours) after preterm amniorrhexis. When begun after the onset of contractions following PPROM, tocolysis generally does not prolong the latency period, although some prolongation may occur before 28 weeks gestational age. Prophylactic tocolysis begun before the onset of labor increases the likelihood of delaying the onset of labor for 1-2 days, but not beyond. Aggressive long-term tocolysis may increase the maternal risk of chorioamnionitis and endometritis. None of the reviewed randomized studies demonstrated a significant neonatal risk. None of these studies showed an improvement in neonatal outcome, although they have not tested the combination of tocolysis and corticosteroid use with appropriate controls. The hypothesis that PROM remote from term should be managed with 1- 2 days of prophylactic tocolysis and corticosteroids to enhance fetal pulmonary maturity is attractive, yet it remains inadequately evaluated.