If do amniocentesis obtain cultures and Gram stain. Digital examination precipitates labor and increases the risk of ascending infection. This probably occurs because of disruption of the cervical mucous by the examining finger. C-SXN reserved for usual obstetrical indications, there is increased maternal risk if chorioamnionitis present. May do c-sxn however if suspect very virulent infection.
Active labor is the most common indication for delivery.
Tocolysis doesn't seem to work in PROM especially with a preterm infant. Main benefit is likely for infection with group B strep. Ampicillin 2 gm IV with the onset of labor then 1 gm IV q4h. WBC of limited utility. A 48 hour delay in delivery appears to promote fetal lung maturation.