Clinician's Approach to Antibiotic Treatment and Management of Preterm Prelabour Rupture of Membranes (PPROM) in Australia and Aotearoa New Zealand—A Survey

Abstract

Background: Preterm prelabour rupture of membranes (PPROM) is a common obstetric complication with significant maternal and foetal consequences. There is a lack of contemporary evidence regarding the optimal management of PPROM, including the best antibiotic regimen and management at previable gestations. Aims: To understand the contemporary management of PPROM among clinicians in Australia and Aotearoa New Zealand. Materials and Methods: An anonymous web-based survey was designed and distributed, consisting of 31 questions about individual clinicians' routine management of PPROM across a range of different gestations. Results: The survey was completed by 235 clinicians from across Australia and Aotearoa New Zealand. The majority (225/232, 97%) routinely prescribed prophylactic antibiotics after PPROM, with 90 different antibiotic regimens documented. The most commonly prescribed prophylactic antibiotics were erythromycin (198/225, 88%) and penicillins (103/225, 46%). There was variation in practice regarding the timing of birth after PPROM, with 62% (147/235) routinely delaying birth until after 37 weeks of gestation, and 61% (143/235) expediting birth after 34 weeks of gestation if Group B Streptococcus was cultured antenatally. For previable PPROM (< 22 weeks of gestation), 74% (171/232) of women were routinely admitted to hospital at the time of diagnosis and 77% (173/225) were routinely offered antibiotics. There was significant variation in the earliest gestational ages at which antenatal corticosteroids and resuscitation are offered. Conclusions: We observed wide variation in clinical practice of management of PPROM. With a lack of national consensus regarding optimal management of this common pregnancy complication, contemporary clinical trials to define best practices are required.