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Premature Rupture of Membranes

Premature rupture of membranes (PROM) is defined as rupture of membranes before the onset of labor is described as. Preterm PROM occurs before 37 weeks of gestation. The etiology of spontaneous PROM is not known; however, it is often suggested that uterine contractions (frequently undetected by the patient) result in cervical change and that an intense inflammatory reaction of the chorioamnion leads to rupture. The

The latent period is the interval between membrane rupture and the onset of labor. Generally, the earlier in gestational age that rupture of membranes occurs, the longer the latent period. More than 90% of patients with PROM begin labor within 24 hours. In patients with preterm PROM, however, labor begins within 24 hours of rupture in only 70% of patients and within 72 hours in 90% of patients. Of patients with ruptured membranes before 34 weeks of gestation, 93% will deliver in less than 1 week premature rupture of membranes, bag of waters, rupture of waters.

In pregnancies of less than 37 weeks of gestation, preterm birth (and its sequelae) and infection are the major concerns after PROM. Chorioamnionitis should be treated aggressively with antibiotics and


The diagnosis of PROM depends on history, physical examination, and laboratory evaluation. The patient's history alone is correct in more than 90% of patients. Digital examination of patients who are not in labor and for whom induction is not planned should be avoided because such examinations add no useful information


After admission and evaluation to exclude infection and fetal distress, management depends on gestational age. Based on these factors and individual circumstances, management in the hospital or with selected patients at home with careful observation is feasible.


At 36 weeks of gestation and beyond, delivery is the ideal management of PROM. Patients in

26-35 WEEKS

Because the major risks to the baby after preterm PROM are related to prematurity, management is directed toward prolonging gestation when there is no labor, no infection, and no evidence of cord compression on

In patients with a positive cervicovaginal culture for group B streptococci or gonococci, however, it is appropriate to treat with antibiotics. Use of intrapartum penicillin during labor in group B Streptococcus-positive women with preterm PROM decreases neonatal sepsis. Recent evidence suggests...