Premature Rupture of the Membranes

Premature rupture of the fetal membranes (PROM) complicates approximately 10% of pregnancies and is responsible for about one-quarter of preterm deliveries. Spontaneous membrane rupture occurs physiologically at term either before or after the onset of symptomatic contractions. The characteristics of PROM of clinical import include latency from membrane rupture to delivery, increased risk of intrauterine and neonatal infection, and complications of oligohydramnios. Clinical chorioamnionitis is common after preterm PROM and increases with decreasing gestational age at membrane rupture. Diagnosis of PROM can usually be made clinically based on a suggestive history combined with a sterile speculum examination. Conditions that mandate delivery after preterm or term PROM include clinical chorioamnionitis, nonreassuring fetal testing, significant vaginal bleeding, progressive labor and concurrent pregnancy complications indicating delivery. Women with a history of preterm birth, especially that due to preterm PROM, are at increased risk for recurrent preterm birth due to PROM.