Prelabor rupture of membranes (PROM)

Learning objectives

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is the breakage of the amniotic sac before the onset of labor
It may occur at term (≥37+0 weeks of gestation) or preterm (<37+0 weeks of gestation), the latter is preterm PROM (PPROM)
Occurs in approximately 8% of term pregnancies and 30% of preterm pregnancies
50% of patients will deliver within one week

Classification

PROM: Rupture happens early, at least one hour before labor has started
Prolonged PROM: More than 18 hours have passed between the rupture and the onset of labor
Preterm PROM (PPROM): Rupture occurs before 37 weeks of gestation
Midtrimester PPROM or previable PPROM (<1%): Rupture occurs before 24 weeks of gestation, the fetus cannot survive outside of the mother’s uterus before this age

Painless gush or steady leakage of fluid from the vagina
Loss of fluid may be associated with the baby becoming easier to feel through the belly, decreased uterine size, or meconium seen in the fluid

Maternal

Fetal

Premature birth and related complications (e.g., bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, cerebral palsy)
Umbilical cord compression or umbilical cord prolapse
Infection (e.g., sepsis)
Abnormal fetal presentation (e.g., breech presentation)

Infection: Infection of the amniotic fluid (chorioamnionitis), urinary tract infections, sexually transmitted diseases, lower genital tract infections (e.g., bacterial vaginosis)
Prior PROM or preterm delivery in previous pregnancies
Polyhydramnios
Multiple gestation
Vaginal bleeding
Maternal smoking
Maternal drug use
Mother who is underweight, nutritional deficits
Invasive procedures (e.g., amniocentesis)
Cervical insufficiency (i.e., short or prematurely dilated cervix during pregnancy)

Treatment depends on the gestational age of the pregnancy, health status of the fetus, and whether complications are present

Delivery: Fetal compromise, infection, or evidence of fetal lung maturity or gestational age ≥34 weeks
Expectant management: Treatment to delay labor including precautions like bed rest, medications (i.e., antibiotics, corticosteroids, and magnesium sulfate), and frequent monitoring for infection or fetal distress

Any woman with a history of preterm delivery (with or without PROM) is recommended to take progesterone supplementation to prevent a recurrence