Steroid courses:
- •22w5d–23w5d — situational, depends on patient/provider preference (wait for joint NICU/MFM counseling).
- •24–34 wks — everyone gets BMZ 12 mg IM q24h × 2 doses.
- •34w0d–36w6d — ALPS counseling. DO NOT tocolyze for steroids, but in stable PPROM, can delay augmentation × 12h.
GBS prophylaxis (if positive or unknown):
- •Ampicillin 2 g IV initial dose, then 1 g IV q4h until delivery.
Mag neuroprotection (viability up to 31w6d, for 12 hours, if delivery imminent):
- •≥ 26 weeks: load 6 g, then 2 g/hr
- •< 26 weeks: load 4 g, then 2 g/hr
Tocolysis:
- •IV fluid bolus 1–2 L over 1–4 hours.
- •23w0d–31w6d: Indomethacin — 50 mg loading dose, then 25 mg PO q6h for total of 48 hours.
- •32w0d–33w6d: Consider nifedipine — 20 mg IR PO loading dose, then 10 mg IR PO q6h × 48 hours.