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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) is the term used when the pregnancy is less than 37 completed weeks of gestation. PPROM occurs in 3 percent of pregnancies and is responsible for, or associated with, approximately one-third of preterm births.

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 glucocorticoids
  • Methods of testing for maternal/fetal infection
  • Timing of delivery.

The risk factors, diagnosis, and management of PPROM will be discussed here. Issues specifically relating to management of midtrimester and term PROM are discussed separately. (See "Midtrimester preterm premature rupture of membranes" and "Management of premature rupture of the fetal membranes at or near term".)

ETIOLOGY AND RISK FACTORS

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'.)
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