Preterm Premature Rupture of Membranes

Preterm premature rupture of membranes (PPROM) refers to rupture of the fetal membranes prior to 37-0/7 weeks’ gestation and prior to the onset of labor. PPROM complicates 2-4% of singleton pregnancies and 7-20% of twin pregnancies, and has been implicated in 30-40% of preterm births. Antepartum management involves confirming the diagnosis, excluding contraindications to expectant management (such as stillbirth, nonreassuring fetal testing, and intrauterine infection), and continued inpatient care with perinatology/NICU consultation, antenatal corticosteroids, broad-spectrum antibiotics (to prolong latency), and serial fetal surveillance. Delivery is indicated in the setting of nonreassuring fetal testing, intrauterine infection, excessive vaginal bleeding, preterm labor, and/or a gestational age of 34 weeks or beyond. Latency (time from rupture of membranes to delivery) depends on gestational age, severity of oligohydramnios, number of fetuses (shorter in twins), pregnancy complications (placental abruption, infection), fetal wellbeing, and use of broad-spectrum antibiotics. PPROM cannot be accurately predicted or prevented. Appropriate evidence-based management is essential to optimize outcome for both the mother and fetus in the setting of PPROM. This review contains 1 table, 2 figures and 57 references. Key words: chorioamnionitis, preterm birth, perinatal morbidity, twin pregnancies, preterm premature rupture of membranes (PPROM), fetal complications, maternal complications, labor and delivery, inpatient care, antepartum management