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Premature Rupture of Membranes at Term (Term PROM)


General Information


  • rupture of chorioamniotic membranes prior to onset of labor at 37 weeks gestation or beyond1,2

Also called

  • term PROM
  • prelabor rupture of membranes



General references used

  1. ACOG Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 188: prelabor rupture of membranes. Obstet Gynecol 2018 Jan;131(1):e1OpenInNew
  2. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Term prelabour rupture of membranes (term PROM). RANZCOG 2017 Mar PDFPictureAsPdf

Recommendation grading systems used

  • Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) grading system
    • recommendation category
      • Evidence-based
        • Grade A - body of evidence can be trusted to guide practice
        • Grade B - body of evidence can be trusted to guide practice in most situations
        • Grade C - body of evidence provides some support for recommendation(s) but care should be taken in its application
        • Grade D - body of evidence is weak and recommendation must be applied with caution
      • Consensus-based - clinical opinion and expertise as insufficient evidence available
      • Good Practice Note - practical advice and information based on clinical opinion and expertise
    • Reference - RANZCOG guideline on term prelabour rupture of membranes (term PROM) (RANZCOG 2017 Mar PDFPictureAsPdf)
  • American College of Obstetricians and Gynecologists (ACOG) grades of recommendation
    • Level A - recommendations based on good and consistent scientific evidence
    • Level B - recommendations based on limited or inconsistent scientific evidence
    • Level C - recommendations based primarily on consensus and expert opinion
  • World Health Organization (WHO) classification of recommendations
    • strength of recommendation
      • Strong - panel is confident that desirable effects of adherence to recommendation outweigh undesirable effects
      • Conditional - panel concludes that desirable effects of adherence to recommendation probably outweigh undesirable effects, but 1 of following conditions applies
        • recommendation only applicable to specific group, population, or setting
        • new evidence may result in changing balance of risk to benefit
        • benefits may not warrant cost or resource requirements in all settings
      • No recommendation possible - further research required before any recommendation can be made
    • quality of evidence
      • High - further research very unlikely to change confidence in estimate of effect
      • Moderate - further research likely to have important impact on confidence in estimate of effect and may change estimate
      • Low - further research very likely to have an important impact on confidence in estimate of effect and likely to change estimate
      • Very low - any estimate of effect very uncertain
    • Guidelines Development Group (GDG) consensus - insufficient evidence to make a recommendation so GDG consensus used as the basis of recommendation
    • Reference - World Health Organization (WHO) recommendations for prevention and treatment of maternal peripartum infections can be found at WHO 2015 PDFPictureAsPdf

Synthesized Recommendation Grading System for DynaMed

  • DynaMed systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based MethodologyOpenInNew).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow DynaMed users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed (DM), we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE)OpenInNew to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed (DM) synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed-initiated groups:
      • Clinical questions will be formulated using the PICO (Population, Intervention, Comparison, Outcome) framework for all outcomes of interest specific to the recommendation to be developed.
      • Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development.
      • Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
      • Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject(s) pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development.
      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
    • Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

Special acknowledgements

  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of DynaMed Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors are employees of DynaMed and oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115900, Premature Rupture of Membranes at Term (Term PROM); [updated 2018 Nov 30, cited place cited date here]. Available from Registration and login required.
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    Overview and Recommendations

    • Background

    • Evaluation

    • Management

  • Related Summaries

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    General Information

    • Description

    • Also called

    • Definitions

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    • Who is most affected

    • Incidence/Prevalence

    • Likely risk factors

    • Possible risk factors

    • Factors not associated with increased risk

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    Etiology and Pathogenesis

    • Causes

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    History and Physical

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      • Chief concern (CC)

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      • General physical

      • Abdomen

      • Pelvic

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    • Making the diagnosis

    • Differential diagnosis

    • Testing overview

    • Other diagnostic testing

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    • Management overview

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      Labor induction

      • General information

      • Medications for labor induction

      • Mechanical methods for labor induction

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      • Antibiotics

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      Other management

      • Expectant management

      • Acupuncture

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    Complications and Prognosis

    • Complications

    • Prognosis

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    Prevention and Screening

    • Prevention

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    Quality Improvement

    • Choosing Wisely

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    Guidelines and Resources

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      • International guidelines

      • United States guidelines

      • United Kingdom guidelines

      • Australian and New Zealand guidelines

    • Review articles

    • MEDLINE search

  • Patient Information

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    ICD Codes

    • ICD-10 codes

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    • General references used

    • Recommendation grading systems used

    • Synthesized Recommendation Grading System for DynaMed

    • DynaMed Editorial Process

    • Special acknowledgements

    • How to cite

Topic Editor
Mary E. Fleming MD, MPH

Medical Director, Valley Birthplace and Women Care; Maryland, United States; Clinical Volunteer, Catholic Medical Mission Board; Maryland, United States

Conflicts of Interest

Dr. Fleming declares no relevant financial conflicts of interest.

Recommendations Editor
Allen Shaughnessy PharmD, M Med Ed, FCCP

Professor of Family Medicine and Director of Master Teacher Fellowship, Tufts University; Massachusetts, United States

Conflicts of Interest

Dr. Shaughnessy declares no relevant financial conflicts of interest.

Deputy Editor
Alan Ehrlich MD, FAAFP

Executive Editor, DynaMed; Associate Professor of Family Medicine, University of Massachusetts Medical School; Massachusetts, United States

Conflicts of Interest

Dr. Ehrlich declares no relevant financial conflicts of interest.

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