Saturday afternoon’s Edith Louise Potter Memorial Lecture will discuss the risks and benefits of delivery for PPROM at 34 weeks versus expectant management.
“Delivering PPROM at 34 Weeks or Not: RDS or Sepsis” goes from 2:10 to 3 pm in Ballroom D. The session will open with a review of what PPROM is, the risk factors, clinical course, and complications.
Catherine Y. Spong, MD, deputy director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), will argue that there should be no change to the ACOG recommendation of delivery at 34 weeks in the setting of preterm premature rupture of membranes.
George R. Saade, MD, professor of obstetrics and gynecology, professor of cell biology, director of the Perinatal Research Division, chief of obstetrics and maternal-fetal medicine and the Jennie Sealy Smith Distinguished Chair in Obstetrics and Gynecology at the University of Texas Medical Branch, Galveston, will take the other side in the debate.
Dr. Saade said that enough evidence exists that supports waiting longer in some cases to give the fetus more time to mature. A systematic review of randomized trials show that morbidity from prematurity is higher in PPROM pregnancies delivered by 34 weeks. Each case should be individualized, Dr. Saade said.
“Shared decision making about management should include discussion with the patient about risks and benefits of delivery versus expectant management,” he said.
Dr. Spong noted that this is an important and interesting question, but the current data doesn’t clearly indicate that changing the recommendations will lead to improved outcomes. Research is needed to determine any potential benefits of ongoing expectant management for a more advanced gestational age and whether it would be offset by the potential risks associated with longer latency.
“We are currently at a state of equipoise and need the data to move forward,” she said. “We shouldn’t make decisions without data because oftentimes what we think is not actually what the data shows. We need to get the data that’s needed to provide the underpinnings for change in practice.”