Outpatient Antibiotics Following Previable Rupture of Membranes (pPPROM) Between 18 0/7 and 22 6/7 Weeks Gestational Age

Inclusion Criteria:

• English-speaking

• Pregnant

• Live, singleton gestation

• Patient able to provide informed consent

• Gestational age between 18 weeks and 0 days and 22 weeks and 6 days at the time of -membrane rupture

• Diagnosis of preterm, prelabor rupture of membranes by clinical exam findings ofeither 1) visualization of amniotic fluid passing from the cervical canal and/orpooling in the vagina via sterile speculum examination, 2) a basic pH (i.e.,positive nitrazine) test of vaginal fluid, 3) arborization (i.e., ferning) of driedvaginal fluid identified via microscopic examination, and/or 4) an amniotic fluidindex (AFI) of less than 4cm

Exclusion Criteria:

• Gestational dating performed or confirmed by ultrasound at ≥ 18 weeks and 0 daysgestational age

• Patient desires pregnancy interruption or induction of labor

• Known major fetal anomaly or aneuploidy

• Amniocentesis ≤ 7 days of diagnosis of rupture of membranes

• Cervical cerclage placement ≤ 7 days of diagnosis of rupture of membranes

• Known drug allergy or significant adverse reactions to macrolide or penicillinantibiotics

• Current antibiotic use at the time of membrane rupture diagnosis

• Vaginal bleeding at the time of membrane rupture diagnosis or within first 24 hoursfrom diagnosis

• Febrile at the time of membrane rupture diagnosis (i.e., temperature ≥ 38 degreesCelsius) and/or within first 24 hours of diagnosis

• Active preterm labor at the time of membrane rupture diagnosis (i.e., consistentcontraction pattern associated with cervical change) and/or within first 24 hours ofdiagnosis

• Cervical dilation of ≥ 4 cm

• Prolapse of fetal parts beyond the level of the internal cervical os

• Declination to complete full, 7-day outpatient monitoring prior to hospitalre-admission should rupture occur during the 22nd week of gestation