Abstract
Introduction: Premature rupture of membranes remains a challenge for professionals due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. Objective: To analyze the scientific production about premature rupture of membranes in pregnancies above 28 weeks and below 34 weeks. Methods: Integrative literature review carried out in the Lilacs, SciELO, Medline and Cochrane Library databases, between 2014 and 2018, in Portuguese, English and Spanish, including original articles, available in full online, with free access, that addressed the study theme, using the keywords "premature rupture of ovular membranes", "premature labor" and "pregnancy complications" combined using the Boolean operators "AND" and "OR". Results: Fourteen studies were included. It was possible to highlight the main recommendations regarding preterm premature rupture of membranes, divided into six categories for discussion, namely: indications for expectant management and delivery induction, prophylactic antibiotic therapy, prenatal corticosteroids, use of tocolytics, recommendations regarding the use of magnesium sulfate and amniocentesis. Conclusion: It was identified that expectant management is the ideal approach, with constant monitoring of the pregnant woman and the fetus, in addition to the administration of prophylactic antibiotics and prenatal corticosteroids, in the face of premature rupture of membranes in pregnancies between 28 and 34 weeks in order to provide the best maternal and perinatal results, guiding health professionals to evidence-based practice.
Highlights
The premature rupture of membranes (PROM) is the spontaneous separation of the chorionic and amniotic membranes before the onset of labor, regardless of gestational age[1]
The American College of Obstetricians and Gynecologists (ACOG) conceptualizes that, when it occurs before 37 weeks of gestation, it is termed preterm premature rupture of membranes (PPROM)[2]
A total of 8 (57.1%) of the included publications were extracted from Medical Literature Analysis and Retrieval System Online (Medline) database, followed by 4 (28.6%) from Cochrane and 2 (14.2%) from Scientific Eletronic Library Online (SciELO)
Summary
The premature rupture of membranes (PROM) is the spontaneous separation of the chorionic and amniotic membranes before the onset of labor, regardless of gestational age[1]. According to the commission specialized in prenatal care from the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), PPROM has an incidence of 2 to 3% of all pregnancies and is responsible for 32.6% of premature births in the United States of America and 18.2% in Brazil[1] It continues to be a challenge for obstetricians due to the high rates of maternal and neonatal morbidity and mortality, mainly related to complications resulting from prematurity. Diagnosis is primarily made by the pregnant woman's history, with reports of fluid loss through the vaginal canal, and physical examination It is recommended for the speculum examination to be performed sterilely and vaginal touches avoided, unless they are extremely necessary, to decrease the risk of intra-amniotic infection[2]. After an initial evaluation of the pregnant woman and the fetus for factors that indicate immediate induction of labor, such as established intra-amniotic infection, active labor and fetal distress, expectant management is considered[8]
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