Management of Preterm Premature Rupture of the Membranes

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Abstract
Premature rupture of the membranes (PROM) can result from a wide array of pathobiologic mechanisms, acting individually or in concert. The gestational age at membrane rupture has significant implications about the etiology, consequences, and management. PROM before term is a leading cause of complications related to prematurity. Oligohydramnios after membrane rupture at any gestational age may cause life-threatening umbilical cord compression. Prolonged membrane rupture increases the risk of maternal and neonatal infection. In some cases, management will be dictated by the presence of overt intrauterine infection, advanced labor, or evident fetal compromise at presentation. With membrane rupture remote from term, particularly near the limit of fetal viability, the physician has the opportunity to intervene in a manner that can significantly affect maternal and infant morbidity. Membrane rupture before fetal viability is associated with significant fetal and maternal risk, regardless of management. An accurate assessment of gestational age and knowledge of the maternal, fetal, and neonatal risks with either pregnancy prolongation or early delivery is essential to appropriate evaluation, counseling, and management of the gravida with PROM. This article will review issues relevant to the management of PROM before term (preterm PROM; PPROM). In addition to discussing those issues general to PPROM, we will briefly discuss several adjunctive treatments that are addressed elsewhere in this symposium. There is controversy surrounding many aspects of PPROM, and some of these issues will be addressed.