Is there a role for tocolytic therapy during conservative management of preterm premature rupture of the membranes?

Conservative management of preterm premature rupture of the membranes (pPROM) remote from term has been associated with significant pregnancy prolongation and has been shown to reduce infant complications when prophylactic antibiotics and antenatal corticosteroids are given concurrently. However, the majority of conservatively managed women with pPROM will deliver within 1 week and do not accrue the benefits of extended pregnancy prolongation. The utility of tocolytic therapy after pPROM remains controversial, but 2 recent surveys of clinician practice revealed frequent utilization of tocolysis after pPROM, with magnesium sulfate being the most commonly used agent. In this manuscript, we review the currently available literature regarding the efficacy, risks, and benefits of tocolytic therapy during conservative management of preterm PROM remote from term.