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Importance: For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.Objective: In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).Evidence Acquisition: Original research articles, review articles, and guidelines on management of late PPROM.Results: Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.Conclusions and Relevance: We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After participating in this activity, the provider should be better able to summarize current evidence regarding fetal, maternal, and obstetric outcomes between immediate delivery and expectant management of patients with PPROM in the late preterm period; describe clinical evaluation of women who present with PPROM in the late preterm period; and plan adequate counseling on the risk and benefits of immediate delivery or expectant management to women who present with PPROM in the later preterm period.Preterm prelabor rupture of membrane (PPROM) is defined as membrane rupture before the onset of labor that occurs before 37 weeks of gestation. Annually, PPROM complicates 2% to 3% of all pregnancies in the United States and is strongly associated with fetal mortality and morbidity. 1 For patients who experience PROM at term (37 weeks or beyond), there is good evidence to support immediate delivery. 2 By contrast, expectant management is advised for patients at very premature gestations (gestational age less than 34 weeks), because the risk of serious neonatal complications such as intraventricular hemorrhage or death increases with increasing prematurity. 3 However, for patients with late Sarah W. Freeman has disclosed that the U.S. Food and Drug Administration has not approved the use of any drugs or devices for the treatment of preterm prelabor rupture of membrane as discussed in this article. Please consult the product's labeling for approved information.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations...

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INTRODUCTION: ACOG recommends early screening for glucose intolerance in obese women, who are at increased risk of insulin resistance. We aimed to assess the risk of developing GDM based on the value of a normal early 50g oral glucose challenge test (GCT). METHODS: Retrospective cohort of non-anomalous singleton pregnancies with maternal BMI ≥40 at one institution, 2013–2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, fetal macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total pregnancy weight gain, labor induction, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women with early GCT >100 and women who with early GCT 101–134. Regression models used to estimate odds of primary outcome. RESULTS: Of 169 women, 66 (39%) had an early GCT <100, and 103 (61%) had an early GCT of 101–134. Women with low normal eGCT were more likely to use recreational drugs (P=.03). Other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between women with a low normal eGCT and high normal eGCT (P=.9). The median neonatal birthweight was higher in the normal GCT group as compared to the low GCT (P=.03). CONCLUSION: Among women with class 3 obesity, the specific value of an early normal GCT was not predictive of developing GDM by the third trimester.