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The government has highlighted the importance of reducing inequalities in health and providing an equal and high quality service to all patients. The district nursing service in Wolverhampton monitors the provision of services across the town to ensure high quality care for all patients.

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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