Preterm premature rupture of membranes

Premature membrane rupture (PMR) is when the ovary membranes break before the beginning of the delivery, with its consequent leak of amniotic fluid. Pre-term PMR is the one that develops before the 17th week of gestation. This situation makes all singleton pregnancies 2-4% more complicated, 7-20% for twin pregnancies and 30% for premature deliveries.

Premature rupture of membranes (PROM) is the rupture of the amniotic sac before labor begins, resulting in the leakage of amniotic fluid. Preterm PROM is when this occurs before the 37th week of pregnancy.

The diagnosis of PROM is clinical, evidenced by fluid leakage during a gynecological exam.

In some cases, the fluid loss may be minimal, leading to uncertainty. In these cases, tests such as the vaginal pH test, fetal ultrasound, and biochemical tests are needed to assess whether the fluid is indeed amniotic fluid.

Once preterm PROM is confirmed, management should be individualized. It is critical to weigh the risks of infection with delayed delivery against the risks of fetal immaturity. Signs of fetal distress or infection (e.g., persistent fetal distress or uterine pain with fever) indicate the need for delivery. In other cases, delivery may be delayed for a variable period of time if the fetal lungs are still immature, with close fetal monitoring, antibiotics, and sometimes corticosteroids to accelerate fetal lung maturation.