Definition of PPPROM in Obstetrics
PPPROM stands for Preterm Premature Rupture of Membranes, which is defined as the rupture of fetal membranes before labor begins and before 37 weeks of gestation. 1
Detailed Explanation
PPPROM is characterized by:
- Spontaneous rupture of the amniotic sac before the onset of labor (pre-labor) 1, 2
- Occurring before 37 weeks of gestation 1, 2
- Affecting approximately 3% of all pregnancies 2, 3
- Contributing to about one-third of all preterm births 2, 3
Clinical Significance
PPPROM is associated with significant maternal and neonatal risks:
- Maternal infectious morbidity and mortality 1
- Neonatal morbidity and mortality related to prematurity 1, 2
- Risk of umbilical cord compression due to oligohydramnios 2, 4
- Increased risk of placental abruption 2, 4
Classification by Gestational Age
PPPROM can be further categorized based on gestational age:
- Previable PPPROM: Occurs when the fetus would not survive outside the uterus and is not a candidate for life-sustaining interventions 1
- Periviable PPPROM: Occurs during the period when the fetus may survive outside the uterus with life-sustaining interventions but still with high risk of death or severe morbidities (typically 20 0/7 to 25 6/7 weeks) 1
- Early PPPROM: Before 34 weeks gestation 5
- Late PPPROM: Between 34-36 weeks + 6 days gestation 5, 6
Management Implications
The diagnosis of PPPROM significantly impacts pregnancy management:
- Management strategies differ based on gestational age at membrane rupture 1, 5
- Early PPPROM (<34 weeks) is typically managed expectantly when possible 5
- Late PPPROM (34-36+6 weeks) may be managed either by immediate delivery or expectantly after patient counseling 5, 6
- All patients with previable and periviable PPPROM should be offered abortion care, and expectant management can also be offered in the absence of contraindications 1
Common Diagnostic Methods
PPPROM is diagnosed through:
- Clinical history and sterile speculum examination 2
- Nitrazine test (pH indicator) 2, 5
- Ferning test (microscopic examination of dried amniotic fluid) 2, 5
- Newer diagnostic tests like Amnisure (placental alpha microglobulin-1) and Actim PROM (insulin-growth factor binding protein-1) 2, 5
Important Considerations
- PPPROM has a high recurrence risk in subsequent pregnancies 2
- Subclinical intrauterine infection is implicated as a major etiological factor 3
- Positive amniotic fluid cultures are found in 25-40% of PPPROM cases at presentation 3
- The majority of women with PPPROM will deliver within 7 days following rupture 1