Abstract：
Previable and periviable preterm prelabor rupture of membranes are challenging obstetrical complications to manage given the substantial risk of maternal morbidity and mortality, with no guarantee of fetal benefit. The following are the Society for Maternal-Fetal Medicine recommendations for the management of previable and periviable preterm prelabor rupture of membranes before the period when a trial of neonatal resuscitation and intensive care would be considered appropriate by the healthcare team and desired by the patient: (1) we recommend that pregnant patients with previable and periviable preterm prelabor rupture of membranes receive individualized counseling about the maternal and fetal risks and benefits of both abortion care and expectant management to guide an informed decision; all patients with previable and periviable preterm prelabor rupture of membranes should be offered abortion care, and expectant management can also be offered in the absence of contraindications (GRADE 1C); (2) we recommend antibiotics for pregnant individuals who choose expectant management after preterm prelabor rupture of membranes at ≥24 0/7 weeks of gestation (GRADE 1B); (3) antibiotics can be considered after preterm prelabor rupture of membranes at 20 0/7 to 23 6/7 weeks of gestation (GRADE 2C); (4) administration of antenatal corticosteroids and magnesium sulfate is not recommended until the time when a trial of neonatal resuscitation and intensive care would be considered appropriate by the healthcare team and desired by the patient (GRADE 1B); (5) serial amnioinfusions and amniopatch are considered investigational and should be used only in a clinical trial setting; they are not recommended for routine care of previable and periviable preterm prelabor rupture of membranes (GRADE 1B); (6) cerclage management after previable or periviable preterm prelabor rupture of membranes is similar to cerclage management after preterm prelabor rupture of membranes at later gestational ages; it is reasonable to either remove the cerclage or leave it in situ after discussing the risks and benefits and incorporating shared decision-making (GRADE 2C); and (7) in subsequent pregnancies after a history of previable or periviable preterm prelabor rupture of membranes, we recommend following guidelines for management of pregnant persons with a previous spontaneous preterm birth (GRADE 1C).
摘要：
胎膜早破是具有挑战性的产科并发症的管理，考虑到孕产妇发病和死亡的巨大风险，不能保证胎儿受益。以下是母胎医学协会的建议，用于在医疗团队认为新生儿复苏和重症监护试验是适当的，并且是患者希望的时期之前，管理先前和未来存活的早产胎膜破裂：（1）我们建议患有先前和未来存活的早产胎膜破裂的孕妇接受有关孕产妇和胎儿风险以及流产护理和预期决策管理的益处的个性化咨询。所有先前和可存活的早产胎膜破裂的患者都应接受流产护理。在没有禁忌症的情况下也可以提供GRADE（GRADE1C）；（2）我们建议对孕妇进行抗生素治疗，这些孕妇在早产≥240/7周的胎膜破裂后选择期待治疗（GRADE1B），在200/7至236/7周的胎膜破裂后，可以考虑使用抗生素（GRADE2C），并建议在早产后进行胎膜破裂，然后进行合理的治疗我们建议遵循先前有自发性早产的孕妇的治疗指南(GRADE1C).
