18th June 2019 the RCOG launched two new PPROM information resources: new clinical guidelines and a new patient information leaflet.  Little Heartbeats flagged the continuing need for these resources when the RCOG archived their predecessors two years ago.  Since then we have worked closely with the RCOG to develop these materials, contributing to early drafts and formally responding at the peer review stage with the assistance of our PPROM community.  The result is two excellent resources which engage with many of the complexities and nuances of PPROM.  We believe they will be very useful to both medical professionals and expectant parents, and we thank the authors and the RCOG for their hard work.

 

The complexity about when to deliver was at the heart of the development of these resources.  Dr Thomson, the author of the guideline, undertook significant additional work to deepen understanding of and add clarity to this area, resulting in nuanced, patient-centred advice.  This advice takes into account the fact that the existing evidence relates primarily to cases of PPROM occurring after 34 weeks, that not enough is known about the subgroups for which expectant management is not appropriate, and that prolonged PPROM is a complicated, changeable condition, which requires ongoing monitoring, careful management, and an openness to identifying the right time to deliver. This additional work is in our view one of the strongest and most important aspects of the new guideline and has the potential to save babies’ lives.  We would like to emphasise that the guidelines do not say the pregnancy should continue to 37 weeks after all cases of PPROM, which is the message elements of the media have been disseminating. 

 

While these guidelines specifically address PPROM occurring after 24 weeks, Little Heartbeats has secured support from the RCOG for the development of a new guideline relating to PPROM before 24 weeks. Previable-PPROM was excluded from this guideline due to lack of quality evidence, but the RCOG agree with us completely that quality guidance is still desperately needed, even if quality evidence is lacking. The hope is to tie this guideline in with the results of the UKOSS study relating to pre-viable PPROM which is due to commence in September (a research project upon which Little Heartbeats has worked closely with the Harris Wellbeing Preterm Birth Centre).  In the meantime, women who have experienced PPROM prior to 24 weeks should have an individualised discussion with their medical team, and these resources can still be used as a guide to potential care and management.

 

 

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