Systematic review of national and international clinical practice guidelines for management of preterm prelabor rupture of membranes

OBJECTIVE: Preterm prelabor rupture of membranes is a common pregnancy complication and a major contributor to preterm birth, but lacks contemporary evidence to guide management. This systematic review aims to highlight the areas of consensus and inconsistency between international guidelines. DATA SOURCES: Medline, PubMed, Embase, Google Scholar, and publications from obstetrics and gynecology societies were searched for guidelines published from 2004 until September 2024. STUDY ELIGIBILITY CRITERIA: Clinical practice guidelines addressing preterm prelabor rupture of membranes management published by an international professional medical society or government body were eligible for inclusion. METHODS: A comprehensive search was conducted, with screening and data abstraction completed by 2 independent reviewers. Quality assessment was performed by 3 reviewers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. RESULTS: A total of 17 clinical practice guidelines met the inclusion criteria and were included in the review. Thirteen clinical practice guidelines received a high overall quality score using the AGREE II criteria. All clinical practice guidelines agreed on the use of prophylactic antibiotics and antenatal corticosteroids between 24 and 34 weeks' gestation. Erythromycin alone was recommended by 8 clinical practice guidelines, and uncertainty about the optimal antibiotic regimen was acknowledged by 6 clinical practice guidelines. There was variation in recommendations on the use of antenatal corticosteroids in late preterm and previable gestations, the use of repeat courses of antenatal corticosteroids, the optimal management of previable preterm prelabor rupture of membranes, and timing of birth, especially when group B Streptococcus was detected antenatally. CONCLUSION: This review demonstrated a lack of international consensus on the optimal management of many aspects of preterm prelabor rupture of membranes, with inconsistencies identified in key areas such as selection of antibiotic regimens, use of antenatal corticosteroids in late preterm and previable gestations, and timing of birth. Further research is required to address these knowledge gaps in order to provide consistent guidelines and implement best-practice care.