Here’s a **complete, concise but comprehensive reference on PROM and PPROM (Prelabor Rupture of Membranes / Preterm Prelabor Rupture of Membranes)** — structured medically for study, clinical use, and SEO-ready educational presentation. --- # **Prelabor Rupture of Membranes (PROM) & Preterm PROM (PPROM)** --- ## **Definition** * **PROM (Prelabor Rupture of Membranes):** Spontaneous rupture of fetal membranes **after 37 weeks of gestation** and **before onset of labor**. * **PPROM (Preterm Prelabor Rupture of Membranes):** Rupture of membranes **before 37 completed weeks** of gestation and **before labor begins**. --- ## **Pathophysiology** * Membranes rupture when **the tensile strength of the amniochorion** is overcome by **mechanical stress** or **infection-induced weakening**. * **Matrix metalloproteinases (MMPs)**, cytokines (IL-6, IL-8, TNF-α), and **collagen degradation** play a major role. * **Ascending infection** from the vagina/cervix leads to **chorioamnionitis**, inflammation, and membrane rupture. --- ## **Etiology / Risk Factors** * **Infection:** bacterial vaginosis, chorioamnionitis. * **Cervical factors:** short cervix, cervical incompetence, cerclage. * **Uterine overdistension:** multiple gestation, polyhydramnios. * **Lifestyle:** smoking, low BMI, poor nutrition. * **Procedural:** amniocentesis, prior preterm PROM. * **Others:** trauma, bleeding, connective tissue disorders. --- ## **Clinical Features** * **History:** * Sudden **gush or continuous leakage of clear fluid** per vagina. * May describe “wet underwear” or “trickling” of fluid. * **No contractions initially** (prelabor). * **Examination:** * Sterile speculum exam → **pooling of amniotic fluid** in posterior fornix. * **Avoid digital exam** (increases infection risk). * Check **fetal presentation** and **cervical dilation** only if necessary. * **Maternal findings:** fever, tenderness (if infection). * **Fetal findings:** variable decelerations (cord compression risk). --- ## **Diagnosis** ### **1. Clinical Tests** * **Pooling test:** visualization of fluid in posterior fornix. * **Nitrazine test:** turns blue (pH > 6.5) if amniotic fluid present. * **Fern test:** dried amniotic fluid shows ferning under microscope. * **Amnisure / PAMG-1 / IGFBP-1 tests:** highly sensitive immunoassays. ### **2. Ultrasound** * **Oligohydramnios** (reduced amniotic fluid index). * Check **fetal wellbeing**, **presentation**, **gestational age**, **anomalies**. ### **3. Infection Screening** * Maternal CBC, CRP. * High vaginal/cervical swabs for culture. * Consider amniotic fluid culture if indicated. --- ## **Differential Diagnosis** * Urinary incontinence * Vaginal discharge (infection, semen) * Excessive cervical mucus --- ## **Complications** ### **Maternal:** * **Chorioamnionitis** * **Endometritis** postpartum * **Sepsis** ### **Fetal/Neonatal:** * **Preterm birth (PPROM)** * **Cord prolapse** * **Pulmonary hypoplasia** (if < 24 wks) * **Sepsis / neonatal infection** * **Perinatal mortality** --- ## **Management** ### **1. General Principles** * Confirm diagnosis. * Avoid digital vaginal exam. * Admit and monitor **maternal vitals**, **uterine activity**, **fetal heart rate**. * **Decide based on gestational age & infection status**. --- ### **2. Term PROM (≥37 weeks)** * **If spontaneous labor within 12–24 h:** allow vaginal delivery. * **If not in labor:** * Induce with **oxytocin** after ensuring no contraindications. * **Antibiotic prophylaxis** (GBS prophylaxis if indicated). * Continuous **fetal monitoring**. --- ### **3. Preterm PROM (PPROM, <37 weeks)** | Gestational Age | Management Plan | | ----------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **<24 weeks** | Conservative, counsel regarding poor prognosis; consider termination. | | **24–34 weeks** | **Expectant management** (if no infection or fetal distress). <br> - Hospitalize, observe for infection, labor. <br> - **Antibiotics**: prolong latency (Erythromycin 250 mg q6h × 10 days or Ampicillin + Erythromycin → Amoxicillin + Erythromycin). <br> - **Corticosteroids** (Betamethasone 12 mg IM × 2 doses 24 h apart). <br> - **Magnesium sulfate** for neuroprotection (<32 weeks). <br> - **No tocolysis** if infection suspected. | | **34–36+6 weeks** | Consider delivery after steroid course. Induce labor if favorable. | | **≥37 weeks** | Induction or augmentation of labor. | --- ## **Antibiotics** **Latency regimen (PPROM):** * IV Ampicillin 2 g q6h + Erythromycin 250 mg q6h × 48 h → then PO Amoxicillin 250 mg q8h + Erythromycin 250 mg q6h × 5 days. **GBS prophylaxis:** * Penicillin G 5 million IU IV loading, then 2.5–3 million IU q4h until delivery. --- ## **Indications for Immediate Delivery** * Chorioamnionitis (maternal fever, tenderness, tachycardia). * Fetal distress. * Placental abruption. * Advanced labor. * Non-reassuring biophysical profile. --- ## **Monitoring** * Maternal: temp 4-hourly, pulse, uterine tenderness. * Fetal: daily NST, BPP twice weekly. * WBC, CRP every 2–3 days. --- ## **Prevention** * Treat genital tract infections. * Smoking cessation. * Avoid unnecessary invasive procedures. * Progesterone supplementation in women with prior PPROM or short cervix. --- ## **Patient Counselling** * Explain infection signs (fever, discharge, pain). * Avoid intercourse, douching, or internal exams. * Report decreased fetal movements or fever immediately. * Plan delivery in a facility with neonatal intensive care. --- ## **Prognosis** * **Term PROM:** excellent if timely managed. * **PPROM:** risk increases with earlier gestation; survival improves after 28–30 weeks. --- ## **Tags:** `PROM, PPROM, Prelabor Rupture of Membranes, Preterm Rupture, Obstetrics, Chorioamnionitis, Corticosteroids, Antenatal Care, Betamethasone, Pregnancy Complications` --- Would you like me to create **20 case-based MCQs with answers and explanations** on PROM & PPROM (in a single HTML–CSS–JS file)?