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Expectant manaement
Antibiotics recommended to prolon latency if there
are no contraindications
Sinle-course corticosteroids
CS prophylaxis as indicated
Less than 24 weeks of gestation
Patient counselin
Expectant manaement or induction of labor
Antibiotics are not recommended before viability
CS prophylaxis is not recommended before viability
Corticosteroids are not recommended before
viability
Tocolysis is not recommended before viability
Manesium sulfate for neuroprotection is not
recommended before viability
Abbreviation: CS, roup streptococci.
*Unless fetal pulmonary maturity is documented.
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930 Practice Bulletin Premature Rupture of Membranes OBSTETRICS & GYNECOLOGY
The MEDLINE database, the Cochrane Library, and the
American College of Obstetricians and Gynecologists
own internal resources and documents were used to con-
duct a lit er a ture search to lo cate rel e vant ar ti cles pub-
lished be tween January 1990June 2013. The search was
re strict ed to ar ti cles pub lished in the English lan guage.
Pri or i ty was given to articles re port ing results of orig i nal
re search, although re view ar ti cles and com men tar ies also
were consulted. Ab stracts of re search pre sent ed at sym po-
sia and sci en tif ic con fer enc es were not con sid ered adequate
for in clu sion in this doc u ment. Guide lines pub lished by
or ga ni za tions or in sti tu tions such as the Na tion al In sti tutes
of Health and the Amer i can Col lege of Ob ste tri cians and
Gy ne col o gists were re viewed, and ad di tion al studies were
located by re view ing bib liographies of identified articles.
When re li able research was not available, expert opinions
from ob ste tri ciangynecologists were used.
Studies were reviewed and evaluated for qual i ty ac cord ing
to the method outlined by the U.S. Pre ven tive Services
Task Force:
I Evidence obtained from at least one prop er ly
de signed randomized controlled trial.
II-1 Evidence obtained from well-designed con trolled
tri als without randomization.
II-2 Evidence obtained from well-designed co hort or
casecontrol analytic studies, pref er a bly from more
than one center or research group.
II-3 Evidence obtained from multiple time series with or
with out the intervention. Dra mat ic re sults in un con-
trolled ex per i ments also could be regarded as this
type of ev i dence.
III Opinions of respected authorities, based on clin i cal
ex pe ri ence, descriptive stud ies, or re ports of ex pert
committees.
Based on the highest level of evidence found in the data,
recommendations are provided and grad ed ac cord ing to the
following categories:
Level ARecommendations are based on good and con-
sis tent sci en tif ic evidence.
Level BRecommendations are based on limited or in con-
sis tent scientific evidence.
Level CRecommendations are based primarily on con-
sen sus and expert opinion.
Copyright October 2013 by the American College of Ob ste t-
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Premature rupture of membranes. Practice Bulletin No. 139. American
College of Obstetricians and Gynecologists. Obstet Gynecol 2013;
122:91830.