Diagnosis for Suspected Ruptured Bag of Water
The diagnosis is "Preterm Premature Rupture of Membranes (PPROM)" if occurring before 37 weeks gestation, or "Premature Rupture of Membranes (PROM)" if occurring at or after 37 weeks gestation. 1, 2
Diagnostic Terminology Based on Gestational Age
The specific diagnosis depends on when membrane rupture occurs:
- PROM (Premature Rupture of Membranes): Rupture of fetal membranes after 37 weeks but before labor onset 2, 3
- PPROM (Preterm Premature Rupture of Membranes): Rupture of fetal membranes before 37 weeks gestation and before labor onset 1, 2, 4
Further Classification for PPROM
If the rupture occurs preterm, you should further classify by gestational age to guide management:
- Previable PPROM: Rupture when the fetus would not survive outside the uterus and is not a candidate for life-sustaining interventions 1
- Periviable PPROM: Rupture during 20 0/7 to 25 6/7 weeks when the fetus may survive with life-sustaining interventions but with high risk of death or severe morbidities 1
- PPROM at viable gestational age: Rupture at ≥24-26 weeks when neonatal survival is more favorable 5
Key Diagnostic Characteristics to Document
When documenting the diagnosis, include:
- Gestational age at rupture (critical for management decisions) 5, 1
- Presence or absence of labor (distinguishes PROM/PPROM from spontaneous rupture during labor) 1, 2
- Presence of meconium-stained fluid if applicable (signals potential fetal compromise) 6
- Signs of infection including maternal fever ≥38°C, maternal tachycardia, purulent cervical discharge, fetal tachycardia, or uterine tenderness 6, 7
Critical Pitfall to Avoid
Do not delay diagnosis or treatment while waiting for confirmatory testing if clinical suspicion is high, as infection can progress rapidly without obvious symptoms, especially at earlier gestational ages 7. The diagnosis should be made by combining patient history (sudden gush or continuous leakage of fluid), sterile speculum examination, nitrazine test, and ferning test 2, 3.