Preterm premature rupture of membranes

Premature rupture of membranes (PROM) is the rupture of the ovarian membranes before labour begins, resulting in the leakage of amniotic fluid. Preterm PROM is that which occurs before 37 weeks' gestation.

PROM is diagnosed clinically with evidence of fluid leakage on gynaecological examination.

In some cases, the fluid leakage may be slight and cause doubt. In these cases, it is necessary to carry out some tests to assess whether the leakage is amniotic fluid, such as the vaginal pH test, foetal ultrasound and biochemical tests.

Once preterm PROM is confirmed, management should be individualised. It is important to weigh the risks of infection if delivery needs to be delayed against the risks of foetal immaturity. Signs of foetal compromise or infection (e.g. persistent worrying foetal test results or uterine pain plus fever) are indications for delivery. In other cases, delivery may be delayed for a variable period of time if the foetal lungs are still immature, with close foetal monitoring, antibiotics and sometimes corticosteroids to accelerate the maturation of the foetal lungs.