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Midtrimester preterm premature rupture of membranes

INTRODUCTION

Midtrimester preterm premature rupture of the fetal membranes (PPROM) typically refers to spontaneous rupture of membranes at 16 to 26 weeks of gestation. This is an arbitrary definition, which varies slightly among investigators. Midtrimester PPROM complicates 0.4 to 0.7 percent of pregnancies, and is associated with significant fetal and neonatal morbidity/mortality [1-3].

The etiology, diagnosis, and complications of midtrimester PPROM will be reviewed here. The management of PPROM is discussed separately. (See "Preterm premature rupture of membranes".)

ETIOLOGY

Midtrimester PPROM may be spontaneous or iatrogenic (eg, due to invasive procedures such as cervical surgery, amniocentesis, chorionic villus sampling).

Spontaneous — The pathogenesis of PPROM is not well understood. There are multiple etiologies, mechanical and physiological, that probably share a final common pathway leading to membrane rupture. (See "Fetal membranes: Anatomy and biochemistry", section on 'Pathogenesis of rupture'.)

Risk factors for PPROM are similar to those for preterm labor (table 1). The major risk factors appear to be a history of preterm labor, PPROM, or cervical insufficiency; multiple gestation; and antepartum bleeding. (See "Risk factors for preterm labor and delivery".)
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