Ingles

PRACTICE BULLETINS
COMMITTEE ON PRACTICE BULLETINS—OBSTETRICS
NUMBER PAGE

1 4 6 8 9 10 12 13 17 19 20 22 24 27 29 30 31 33 36 37 38 40 43 44

Premature Rupture of Membranes Prevention of Rh D Alloimmunization Thrombocytopenia in Pregnancy Management of Herpes in Pregnancy Antepartum Fetal Surveillance Induction of Labor Intrauterine Growth Restriction External Cephalic Version OperativeVaginal Delivery Thromboembolism in Pregnancy Perinatal Viral and Parasitic Infections Fetal Macrosomia Management of Recurrent Early Pregnancy Loss Prenatal Diagnosis of Fetal Chromosomal Abnormalities Chronic Hypertension in Pregnancy Gestational Diabetes Assessment of Risk Factors for Preterm Birth Diagnosis and Management of Preeclampsia and Eclampsia Obstetric Analgesia and Anesthesia ThyroidDisease in Pregnancy Perinatal Care at the Threshold of Viability Shoulder Dystocia Management of Preterm Labor Neural Tube Defects

465 475 483 494 503 514 524 536 543 551 561 574 585 597 609 618 632 640 649 664 674 682 688 697

PRACTICE BULLETINS
COMMITTEE ON PRACTICE BULLETINS—OBSTETRICS (Continued)

NUMBER

PAGE

47 48 49 52 54 55 56 58 60 64 68 70

Prophylactic Antibiotics inLabor and Delivery Cervical Insufficiency Dystocia and Augmentation of Labor Nausea and Vomiting of Pregnancy Vaginal Birth After Previous Cesarean Delivery Management of Postterm Pregnancy Multiple Gestation: Complicated Twin, Triplet, and High-Order Multifetal Pregnancy Ultrasonography in Pregnancy Pregestational Diabetes Mellitus Hemoglobinopathies in Pregnancy Antiphospholipid SyndromeIntrapartum Fetal Heart Rate Monitoring

708 716 725 735 748 758 766 781 791 802 811 820 829 835 843 852 859 866 873

*71 Episiotomy *75 Management of Alloimmunization During Pregnancy *76 Postpartum Hemorrhage 230 Assessment of Fetal Lung Maturity 236 Teratology 248 Viral Hepatitis in Pregnancy 251 Obstetric Aspects of Trauma Management

*Published in 2006

ACOG PRACTICE BULLETIN
CLINICALMANAGEMENT GUIDELINES FOR OBSTETRICIAN–GYNECOLOGISTS NUMBER 1, JUNE 1998
This Practice Bulletin was developed by the ACOG Committees on Practice Bulletins— Obstetrics and Gynecology with the assistance of Brian M. Mercer, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating anexclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.

Premature Rupture of Membranes
Preterm delivery occurs in approximately 11% of all births in the United States and is a major factor contributing to perinatal morbidity and mortality. Despiteextensive research in this area, the rate of preterm birth has increased by 17% over the past 15 years (1). Premature rupture of membranes (PROM) is a complication in one quarter to one third of preterm births. In both term and preterm births, numerous controversies exist regarding optimal methods of clinical assessment and treatment of PROM. Management hinges on evaluation of the relative risks ofinfection, cord accident, operative delivery, and of the gestational age in patients not in labor. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research. Additional guidelines based on consensus and expert opinion also are presented to permit a review ofmost clinical aspects of PROM.

Background
The definition of PROM is rupture of membranes before the onset of labor. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm PROM. Premature rupture of membranes can result from a wide array of pathologic mechanisms acting individually or in concert (2). The gestational age at membrane rupture has significant...