is defined as the rupture of the
chorion & amniotic sac more than one
hour before the onset of labor(uterine
uterine contractions of sufficient
frequency and intensity to result in
progressive effacement and dilation of
is considered prolonged when it occurs
more than 18 or 24 hours before labor.
is considered preterm when it
occurs before 37 weeks gestation, and is
called Preterm Premature Rupture of
Membranes (or PPROM)
Latent phase :
the period between rupture of membranes
and beginning of uterine contractions
5-10 % of all term pregnancy PROM.
PPROM in 1% of all pregnancies
PROM is accelerator of 1/3 of preterm
In pt with history of PROM the incidence of
recurrence is 32%
Bacterial infection, (Genital tract infection)
Smoking, Drugs abuse (cocaine)
Anatomic defect in the structure of the amniotic
sac, uterus, or cervix
Acute Inflammation of Placenta
Maternal risk factors
Chorioamnionitis or sepsis
Emotional states of fear and pre labor rupture of
membranes at term
prematurity, infection, cord prolapsed ,mal presentation
or genetic mutations.
Pulse & temperature & a
flushed appearance abdominal
examination may reveal a Clinical
suspicion of oligohydramnios or
uterine tenderness if
chorioamnionitis is present
Single course (two Inj 12-24 hours or 12mg I.M
, 6mg/12hrsx4 doses) given between 24 & 34wks
gestation & received within 7 days of delivery
result improved neonatal outcomes Reduction in
RDS in neonatal.
Max benefit seen after 48 hrs or more than 7
days before delivery lead to benefit below 28
contraction cease spontaneously
Delay preterm labour would improve fetal
outcome without causing harm to mother or
Almost no clinical benefit & only nifedipine may
improve fetal outcome
Nifedipine 20mg PO then 10-20mg/6-8h PO
according to uterine activity
days course of Erythromycin
Iv AB (eg ampicillin 500mg/6h iv + Gentamicin
3-5mg/kg/8hrs) 5-7 days
age over 36 weeks
A. In absence of infection, fetal distress
and abnormal lie, wait for 24 hours as
about 90% of patients with PROM will
pass into spontaneous labor. Prophylactic
antibiotic can be given during this period.
B. PGE2 and / or oxytocin is used for
induction of labor in patients did not pass
into labor after 24 hours.
Gestational age between 34-36 weeks
A. In absence of infection and fetal
distress, wait for 48 hours as rupture of
membrane itself will accelerates lung
surfactant production and hence lung
B. Induce labor after 48 hours with PGE2 and
C. Prophylactic antibiotics are given during this
D. Caesarean section is indicated in breech
presentation < 36 weeks’ gestation.
age between 28-34 weeks
In absence of infection, the main aim is to
manage the case conservatively till the
35th week when lung maturity mostly
occurs and the baby can survive.
a. Rest in bed as long as there is escape of liquor with restriction
of efforts later on particularly those that increase intraabdominal pressure.
b. Temperature is recorded every 4 hours.
c. Observation for malaise, abdominal pain, uterine tenderness
and amount of escaped liquor on sterile vulval pads.
d. Leucocytic count and C-reactive protein may be done every
e. Prophylactic antibiotics may be given although this is not
advised by some authors as it may lead to colonisation of
resistant strains of organisms in the genital tract.
f .Tocolytic drugs: are given if uterine activity starts.
g .Corticosteroid therapy: is given for 48 hours if labor was
imminent or will be induced before 35 weeks.
Gestational age less than 28 weeks
There is little chance of fetal survival and the
condition is usually considered as