{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:21:22Z","timestamp":1787613682227,"version":"build-2736575974"},"reference-count":8,"publisher":"Georg Thieme Verlag KG","issue":"12","funder":[{"name":"NIH T32","award":["HD007203-42"],"award-info":[{"award-number":["HD007203-42"]}]},{"name":"NICHD Women's Reproductive Health Research (WRHR) K12","award":["HD001259-25"],"award-info":[{"award-number":["HD001259-25"]}]},{"name":"NICHD WRHR K12","award":["HD001259-26"],"award-info":[{"award-number":["HD001259-26"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remain mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the nationally published guidelines, and discuss our opinion on the controversy as well as future directions for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34 weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and, worse, if not universally offered in the absence of contraindications to expectant management, may be an area of inequitable or biased care.<\/jats:p>","DOI":"10.1055\/a-2809-6494","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:29:37Z","timestamp":1770856177000},"page":"1688-1692","source":"Crossref","is-referenced-by-count":0,"title":["Expectant Management Beyond 34 Weeks' Gestation Should Be Offered for Preterm Premature Rupture of Membranes"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-3023","authenticated-orcid":false,"given":"Minhazur","family":"Sarker","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, La Jolla, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4523-5009","authenticated-orcid":false,"given":"Jeffrey D.","family":"Sperling","sequence":"additional","affiliation":[{"name":"Department of Maternal Fetal Medicine, Kaiser Permanente Modesto Medical Center, Modesto, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ukachi N.","family":"Emeruwa","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, La Jolla, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth N.","family":"Teal","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego, La Jolla, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1097\/AOG.0000000000003700","article-title":"Prelabor rupture of membranes: ACOG Practice Bulletin, Number 217","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref2","doi-asserted-by":"crossref","first-page":"e152","DOI":"10.1111\/1471-0528.15803","article-title":"Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation: Green-top Guideline No. 73","volume":"126","author":"A J Thomson","year":"2019","journal-title":"BJOG"},{"issue":"11","key":"ref3","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/j.jogc.2022.08.014","article-title":"Guideline No. 430: Diagnosis and management of preterm prelabour rupture of membranes","volume":"44","author":"S Ronzoni","year":"2022","journal-title":"J Obstet Gynaecol Can"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"101563","DOI":"10.1016\/j.ajogmf.2024.101563","article-title":"PPROM in the late preterm period: An argument for expectant management","volume":"7","author":"D Lee","year":"2024","journal-title":"Am J Obstet Gynecol MFM"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/S0140-6736(15)00724-2","article-title":"Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): A randomised controlled trial","volume":"387","author":"J M Morris","year":"2016","journal-title":"Lancet"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1111\/1471-0528.14302","article-title":"An economic evaluation of planned immediate versus delayed birth for preterm prelabour rupture of membranes: Findings from the PPROMT randomised controlled trial","volume":"124","author":"S J Lain","year":"2017","journal-title":"BJOG"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/OGX.0000000000000567","article-title":"Preterm premature rupture of membranes: A review of 3 national guidelines","volume":"73","author":"I Tsakiridis","year":"2018","journal-title":"Obstet Gynecol Surv"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"101562","DOI":"10.1016\/j.ajogmf.2024.101562","article-title":"Preterm premature rupture of membranes in the late preterm period: An argument against expectant management","volume":"7","author":"G Bitar","year":"2024","journal-title":"Am J Obstet Gynecol MFM"}],"container-title":["American Journal of 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