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Preterm premature rupture of membranes

INTRODUCTION

Premature rupture of membranes (PROM) refers to membrane rupture before the onset of uterine contractions; preterm PROM (PPROM) refers to PROM before 370/7ths weeks of gestation.

The management of PPROM is among the most controversial issues in perinatal medicine. Points of contention include:

  • Expectant management versus intervention
  • Use of tocolytics
  • Duration of administration of antibiotic prophylaxis
  • Timing of administration of antenatal corticosteroids
  • Methods of testing for maternal/fetal infection
  • Timing of delivery.

Risk factors, diagnosis, and management of PPROM at 24 to 37 weeks of gestation will be discussed here. Issues specifically relating to management of PROM prior to 24 weeks of gestation and at term are discussed separately. (See "Midtrimester preterm premature rupture of membranes" and "Management of premature rupture of the fetal membranes at term".)

INCIDENCE

Preterm premature rupture of membranes (PPROM) occurs in 3 percent of pregnancies and is responsible for, or associated with, approximately one-third of preterm births [1].

                                           

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Literature review current through: May 2013. | This topic last updated: Jun 7, 2013.
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References
Top
  1. Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32:411.
  2. Harger JH, Hsing AW, Tuomala RE, et al. Risk factors for preterm premature rupture of fetal membranes: a multicenter case-control study. Am J Obstet Gynecol 1990; 163:130.
  3. Mercer BM, Goldenberg RL, Moawad AH, et al. The preterm prediction study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol 1999; 181:1216.
  4. Asrat T, Lewis DF, Garite TJ, et al. Rate of recurrence of preterm premature rupture of membranes in consecutive pregnancies. Am J Obstet Gynecol 1991; 165:1111.
  5. Lee T, Carpenter MW, Heber WW, Silver HM. Preterm premature rupture of membranes: risks of recurrent complications in the next pregnancy among a population-based sample of gravid women. Am J Obstet Gynecol 2003; 188:209.
  6. Ekwo EE, Gosselink CA, Moawad A. Unfavorable outcome in penultimate pregnancy and premature rupture of membranes in successive pregnancy. Obstet Gynecol 1992; 80:166.
  7. Parry S, Strauss JF 3rd. Premature rupture of the fetal membranes. N Engl J Med 1998; 338:663.
  8. Lykke JA, Dideriksen KL, Lidegaard O, Langhoff-Roos J. First-trimester vaginal bleeding and complications later in pregnancy. Obstet Gynecol 2010; 115:935.
  9. Ekwo EE, Gosselink CA, Woolson R, Moawad A. Risks for premature rupture of amniotic membranes. Int J Epidemiol 1993; 22:495.
  10. Berkowitz GS, Blackmore-Prince C, Lapinski RH, Savitz DA. Risk factors for preterm birth subtypes. Epidemiology 1998; 9:279.
  11. Schuller DE, Hamaker RC, Gluckman JL. Mediastinal dissection. A multi-institutional assessment. Arch Otolaryngol 1981; 107:715.
  12. Alexander JM, Mercer BM, Miodovnik M, et al. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet Gynecol 2000; 183:1003.
  13. Schutte MF, Treffers PE, Kloosterman GJ, Soepatmi S. Management of premature rupture of membranes: the risk of vaginal examination to the infant. Am J Obstet Gynecol 1983; 146:395.
  14. Imseis HM, Trout WC, Gabbe SG. The microbiologic effect of digital cervical examination. Am J Obstet Gynecol 1999; 180:578.
  15. Mercer BM, Rabello YA, Thurnau GR, et al. The NICHD-MFMU antibiotic treatment of preterm PROM study: impact of initial amniotic fluid volume on pregnancy outcome. Am J Obstet Gynecol 2006; 194:438.
  16. Mercer BM, Miodovnik M, Thurnau GR, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. JAMA 1997; 278:989.
  17. Soraisham AS, Singhal N, McMillan DD, et al. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol 2009; 200:372.e1.
  18. Williams MA, Lieberman E, Mittendorf R, et al. Risk factors for abruptio placentae. Am J Epidemiol 1991; 134:965.
  19. Vintzileos AM, Campbell WA, Nochimson DJ, Weinbaum PJ. Preterm premature rupture of the membranes: a risk factor for the development of abruptio placentae. Am J Obstet Gynecol 1987; 156:1235.
  20. Ananth CV, Oyelese Y, Srinivas N, et al. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstet Gynecol 2004; 104:71.
  21. Major CA, de Veciana M, Lewis DF, Morgan MA. Preterm premature rupture of membranes and abruptio placentae: is there an association between these pregnancy complications? Am J Obstet Gynecol 1995; 172:672.
  22. Lewis DF, Robichaux AG, Jaekle RK, et al. Expectant management of preterm premature rupture of membranes and nonvertex presentation: what are the risks? Am J Obstet Gynecol 2007; 196:566.e1.
  23. Goodman JR, Lambert AE, Peck JD, et al. Outcomes in cephalic vs noncephalic presentation in the setting of preterm premature rupture of membranes. Am J Obstet Gynecol 2013; 208:231.e1.
  24. Seeds AE, Hellegers AE. Acid-base determinations in human amniotic fluid throughout pregnancy. Am J Obstet Gynecol 1968; 101:257.
  25. Abe, T. The detection of rupture of fetal membranes with the nitrazine indicator. Am J Obstet Gynecol 1940; 39:400.
  26. Davidson KM. Detection of premature rupture of the membranes. Clin Obstet Gynecol 1991; 34:715.
  27. Mulhair L, Carter J, Poston L, et al. Prospective cohort study investigating the reliability of the AmnioSense method for detection of spontaneous rupture of membranes. BJOG 2009; 116:313.
  28. Cousins LM, Smok DP, Lovett SM, Poeltler DM. AmniSure placental alpha microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes. Am J Perinatol 2005; 22:317.
  29. Lee SE, Park JS, Norwitz ER, et al. Measurement of placental alpha-microglobulin-1 in cervicovaginal discharge to diagnose rupture of membranes. Obstet Gynecol 2007; 109:634.
  30. Abdelazim IA, Makhlouf HH. Placental alpha microglobulin-1 (AmniSure(®) test) for detection of premature rupture of fetal membranes. Arch Gynecol Obstet 2012; 285:985.
  31. Marcellin L, Anselem O, Guibourdenche J, et al. [Comparison of two bedside tests performed on cervicovaginal fluid to diagnose premature rupture of membranes]. J Gynecol Obstet Biol Reprod (Paris) 2011; 40:651.
  32. Birkenmaier A, Ries JJ, Kuhle J, et al. Placental α-microglobulin-1 to detect uncertain rupture of membranes in a European cohort of pregnancies. Arch Gynecol Obstet 2012; 285:21.
  33. Akercan F, Cirpan T, Kazandi M, et al. The value of the insulin-like growth factor binding protein-1 in the cervical-vaginal secretion detected by immunochromatographic dipstick test in the prediction of delivery in women with clinically unconfirmed preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2005; 121:159.
  34. Darj E, Lyrenäs S. Insulin-like growth factor binding protein-1, a quick way to detect amniotic fluid. Acta Obstet Gynecol Scand 1998; 77:295.
  35. Erdemoglu E, Mungan T. Significance of detecting insulin-like growth factor binding protein-1 in cervicovaginal secretions: comparison with nitrazine test and amniotic fluid volume assessment. Acta Obstet Gynecol Scand 2004; 83:622.
  36. Gaucherand P, Salle B, Sergeant P, et al. Comparative study of three vaginal markers of the premature rupture of membranes. Insulin like growth factor binding protein 1 diamine-oxidase pH. Acta Obstet Gynecol Scand 1997; 76:536.
  37. Ramsauer B, Vidaeff AC, Hösli I, et al. The diagnosis of rupture of fetal membranes (ROM): a meta-analysis. J Perinat Med 2013; 41:233.
  38. ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007; 109:1007.
  39. van der Ham DP, van der Heyden JL, Opmeer BC, et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012; 207:276.e1.
  40. Al-Mandeel H, Alhindi MY, Sauve R. Effects of intentional delivery on maternal and neonatal outcomes in pregnancies with preterm prelabour rupture of membranes between 28 and 34 weeks of gestation: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013; 26:83.
  41. Buchanan SL, Crowther CA, Levett KM, et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2010; :CD004735.
  42. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; :CD004454.
  43. Harding JE, Pang J, Knight DB, Liggins GC. Do antenatal corticosteroids help in the setting of preterm rupture of membranes? Am J Obstet Gynecol 2001; 184:131.
  44. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 402: Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol 2008; 111:805.
  45. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2010; :CD001058.
  46. Hutzal CE, Boyle EM, Kenyon SL, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 2008; 199:620.e1.
  47. ACOG Committee Opinion No. 445: antibiotics for preterm labor. Obstet Gynecol 2009; 114:1159.
  48. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1.
  49. Grigsby PL, Novy MJ, Sadowsky DW, et al. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model. Am J Obstet Gynecol 2012; 207:475.e1.
  50. Kenyon S, Pike K, Jones DR, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. Lancet 2008; 372:1310.
  51. Kenyon S, Pike K, Jones DR, et al. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet 2008; 372:1319.
  52. Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59:1.
  53. Mackeen AD, Seibel-Seamon J, Grimes-Dennis J, et al. Tocolytics for preterm premature rupture of membranes. Cochrane Database Syst Rev 2011; :CD007062.
  54. Briery CM, Veillon EW, Klauser CK, et al. Women with preterm premature rupture of the membranes do not benefit from weekly progesterone. Am J Obstet Gynecol 2011; 204:54.e1.
  55. Carlan SJ, O'Brien WF, Parsons MT, Lense JJ. Preterm premature rupture of membranes: a randomized study of home versus hospital management. Obstet Gynecol 1993; 81:61.
  56. Turnbull DA, Wilkinson C, Gerard K, et al. Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. Lancet 2004; 363:1104.
  57. Abou El Senoun G, Dowswell T, Mousa HA. Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation. Cochrane Database Syst Rev 2010; :CD008053.
  58. Beckmann M, Gardener G. Hospital versus outpatient care for preterm pre-labour rupture of membranes. Aust N Z J Obstet Gynaecol 2012; :1.
  59. Hanley ML, Vintzileos AM. Biophysical testing in premature rupture of the membranes. Semin Perinatol 1996; 20:418.
  60. Lewis DF, Adair CD, Weeks JW, et al. A randomized clinical trial of daily nonstress testing versus biophysical profile in the management of preterm premature rupture of membranes. Am J Obstet Gynecol 1999; 181:1495.
  61. Leo MV, Skurnick JH, Ganesh VV, et al. Clinical chorioamnionitis is not predicted by umbilical artery Doppler velocimetry in patients with premature rupture of membranes. Obstet Gynecol 1992; 79:916.
  62. Abramowicz JS, Sherer DM, Warsof SL, Levy DL. Fetoplacental and uteroplacental Doppler blood flow velocity analysis in premature rupture of membranes. Am J Perinatol 1992; 9:353.
  63. Carroll SG, Papaioannou S, Nicolaides KH. Doppler studies of the placental and fetal circulation in pregnancies with preterm prelabor amniorrhexis. Ultrasound Obstet Gynecol 1995; 5:184.
  64. Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991; 164:859.
  65. Duff P. Premature rupture of the membranes in term patients. Semin Perinatol 1996; 20:401.
  66. Seaward PG, Hannah ME, Myhr TL, et al. International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. Am J Obstet Gynecol 1997; 177:1024.
  67. Clark P, Duff P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. Am J Obstet Gynecol 1995; 173:1301.
  68. Porat S, Amsalem H, Shah PS, Murphy KE. Transabdominal amnioinfusion for preterm premature rupture of membranes: a systematic review and metaanalysis of randomized and observational studies. Am J Obstet Gynecol 2012; 207:393.e1.
  69. Melamed N, Ben-Haroush A, Pardo J, et al. Expectant management of preterm premature rupture of membranes: is it all about gestational age? Am J Obstet Gynecol 2011; 204:48.e1.
  70. Kunze M, Hart JE, Lynch AM, Gibbs RS. Intrapartum management of premature rupture of membranes: effect on cesarean delivery rate. Obstet Gynecol 2011; 118:1247.
  71. Lin MG, Nuthalapaty FS, Carver AR, et al. Misoprostol for labor induction in women with term premature rupture of membranes: a meta-analysis. Obstet Gynecol 2005; 106:593.
  72. ACOG Committee on Practice Bulletins -- Obstetrics. ACOG Practice Bulletin No. 107: Induction of labor. Obstet Gynecol 2009; 114:386.
  73. Wolff K, Swahn ML, Westgren M. Balloon catheter for induction of labor in nulliparous women with prelabor rupture of the membranes at term. A preliminary report. Gynecol Obstet Invest 1998; 46:1.