From the Guidelines
The key differences among prolonged rupture of membranes (ROM), premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM) relate to timing and gestational age, with PPROM being the most critical due to its association with high rates of maternal and neonatal morbidity and mortality 1. The clinical significance of these conditions varies based on gestational age and duration. Prolonged ROM refers to any rupture of membranes lasting more than 18-24 hours before delivery, regardless of when it occurs during pregnancy. PROM describes rupture of membranes that occurs before the onset of labor at any gestational age. PPROM specifically refers to membrane rupture that occurs before 37 weeks gestation and before labor begins.
Management of PPROM
For PPROM, management typically includes hospitalization, antibiotics, and close monitoring for infection, labor, and fetal well-being. Antibiotics are recommended for pregnant individuals who choose expectant management after PPROM at ≥24 0/7 weeks (GRADE 1B) 1. The antibiotic regimen may include ampicillin and erythromycin, with the goal of reducing the risk of infection. Antenatal corticosteroids may also be considered if less than 34 weeks gestation.
Risks and Outcomes
All three conditions increase the risk of chorioamnionitis, with risk proportional to duration of membrane rupture. The underlying pathophysiology involves bacterial ascension from the lower genital tract after the protective amniotic membrane barrier is compromised, potentially leading to maternal and neonatal infections. Pregnant individuals with previable and periviable PPROM should be counseled about all management options, including abortion care, and individuals who elect expectant management should be provided with the most realistic estimate of perinatal survival and morbidities based on the best available evidence 1.
Key Considerations
- Prolonged ROM: rupture of membranes lasting more than 18-24 hours before delivery
- PROM: rupture of membranes that occurs before the onset of labor at any gestational age
- PPROM: membrane rupture that occurs before 37 weeks gestation and before labor begins
- Management of PPROM: hospitalization, antibiotics, and close monitoring for infection, labor, and fetal well-being
- Risks and outcomes: increased risk of chorioamnionitis, maternal and neonatal infections, and high rates of maternal and neonatal morbidity and mortality.
From the Research
Definitions and Differences
- Prolonged ROM refers to a prolonged period of ruptured membranes, which can increase the risk of infection and other complications.
- PROM (Preterm Rupture of Membranes) refers to the rupture of membranes before the onset of labor, regardless of gestational age.
- PPROM (Preterm Premature Rupture of Membranes) refers to the rupture of membranes before 37 weeks of gestation.
Key Differences
- Gestational age: PPROM occurs before 37 weeks, while PROM can occur at any gestational age.
- Management: PPROM is typically managed with antibiotics and corticosteroids to prolong pregnancy and reduce morbidity, while PROM at term is often managed with induction of labor or expectant management.
- Risks: PPROM is associated with a higher risk of prematurity, infection, and other complications, while PROM at term is generally considered lower risk.
Management of PPROM
- Antibiotic therapy is recommended to reduce infant morbidity and prolong pregnancy, as shown in studies 2, 3, 4.
- Corticosteroids may be administered to promote fetal lung maturity.
- Amniocentesis may be performed to rule out intra-amniotic infection.
- Broad-spectrum antibiotics may be administered if infection is suspected or confirmed.