Skip to main content
SpringerLink
Log in

Prelabor Rupture of Membranes

  • Chapter
  • First Online:
Labour Room Emergencies

Abstract

Spontaneous rupture of membranes is a normal component of labor and delivery. Premature rupture of the membranes is defined as rupture of membranes before the onset of labor, and if it occurs before 37 weeks, it is termed preterm prelabor rupture of membranes (PPROM). If such an event occurs near or beyond term, it raises less concern about the health of the mother and neonate. PPROM, on the other hand, is more challenging due to increased risk of prematurity to the fetus and chorioamnionitis in the mother. Expectant management and immediate delivery are potential options in these patients. In women with PROM at term, labor should be induced immediately, generally with oxytocin. When PROM occurs before 34 weeks of gestation, expectant management is generally advocated, provided there are no maternal or fetal contraindications. They should be given a course of antibiotics (latency antibiotics), corticosteroids for fetal lung maturity, intrapartum group B streptococcal prophylaxis, and magnesium sulfate for neuroprotection if delivery is imminent before 32 weeks. Any evidence of intrauterine infection should be an indication for abandoning the expectant management. When PPROM occurs between 34 and 37 weeks of gestation, the obstetrician faces a clinical dilemma, and different management options are followed according to institutional protocols.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. DC Dutta’s Textbook of Obstetrics, 8th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2015.

    Google Scholar 

  2. ACOG Practice Bulletin No.80: Premature Rupture of Membranes. Clinical management guidelines for obstetrician-gynecologists. ACOG Committee on Practice Bulletins-Obstetrics. Obstet Gynecol. 2007 Apr;109(4):1007–19.

    Article  Google Scholar 

  3. Arias, Daftary, Bhide. Practical guide to high- risk pregnancy & delivery a South Asian perspective, 3/e. New Delhi: Elsevier; 2011.

    Google Scholar 

  4. ACOG Practice Bulletin No.160: Premature Rupture of Membranes. Clinical management guidelines for obstetrician-gynecologists. ACOG Committee on Practice Bulletins. Obstet Gynecol. 2016 Jan;127(1):e39–51.

    Article  Google Scholar 

  5. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003;101(1):178–93.

    PubMed  Google Scholar 

  6. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS, editors. Williams obstetrics. 24th ed. USA: The McGraw-Hill Education; 2014.

    Google Scholar 

  7. Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008;1(1):11–22.

    PubMed  PubMed Central  Google Scholar 

  8. Royal College of Obstetricians & Gynaecologists. Preterm Prelabour Rupture of Membranes. Green-top Guideline No.44; 2010.

    Google Scholar 

  9. El-Messidi A, Cameron A. Diagnosis of premature rupture of membranes: inspiration from the past and insights for the future. J Obstet Gynaecol Can. 2010;32(6):561–9.

    Article  Google Scholar 

  10. Medina TM, Hill DA. Preterm premature rupture of membranes; diagnosis and management. Am Fam Physician. 2006;73(4):659–64.

    PubMed  Google Scholar 

  11. NICE guideline. Preterm labour and birth; 2015. ng25.

    Google Scholar 

  12. Abdelazim IA. Insulin like growth factor binding protein1 (Actim PROM test) for detection of premature rupture of fetal membranes. J Obstet Gynaecol Res. 2014;40(4):961–7.

    Article  CAS  Google Scholar 

  13. Cousins LM, Smok DP, Lovett SM, Poeltler DM. Amnisure placental a microglobulin-1 rapid immunoassay versus standard diagnostic methods for detection of rupture of membranes. Am J Perinatol. 2005;22(6):317–20.

    Article  Google Scholar 

  14. Hallak M, Bottoms SF. Accelerated pulmonary maturation from preterm premature rupture of membranes: a myth. Am J Obstet Gynecol. 1993;169(4):1045–9.

    Article  CAS  Google Scholar 

  15. Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev. 2006;25(1):CD005302.

    Google Scholar 

  16. Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED, Myhr TL, Wang EE, Weston JA, Willan AR. Induction of labour compared with expectant management for prelabour rupture of the membranes at term. TERMPROM Study Group. N Engl J Med. 1996;334(16):1005–10.

    Article  CAS  Google Scholar 

  17. NICE clinical guideline: induction of labour; 2008.

    Google Scholar 

  18. Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. Failed labor induction: toward an objective diagnosis. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Obstet Gynecol. 2011;117:267–72.

    Article  Google Scholar 

  19. Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012;120(5):1181–93.

    PubMed  PubMed Central  Google Scholar 

  20. Flenady V, King JF. Antibiotics for prelabour rupture of membranes at or near term. Cochrane Database Syst Rev. 2002;3:CD001807. https://doi.org/10.1002/14651858.CD001807.

    Article  Google Scholar 

  21. Passos F, Cardoso K, Coelho AM, Graça A, Clode N, Mendes da Graça L. Antibiotic prophylaxis in premature rupture of membranes at term: a randomized controlled trial. Obstet Gynecol. 2012;120(5):1045–51. https://doi.org/10.1097/AOG.0b013e31826e46bc.

    Article  CAS  PubMed  Google Scholar 

  22. Kenyon S, Boulvain M, Neilson J. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev. 2003;2:CD001058.

    Google Scholar 

  23. Simhan HN, Canavan TP. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG. 2005;112(Suppl 1):32–7.

    Article  Google Scholar 

  24. Buchanan SL, Crowther CA, Levett KM, Middleton P, Morris J. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks’ gestation for improving pregnancy outcome. Cochrane Database Syst Rev. 2010;3:CD004735.

    Google Scholar 

  25. Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, Algert CS, Thornton JG, Crowther CA, PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016;387(10017):444–52. https://doi.org/10.1016/S0140-6736(15)00724-2.

  26. Gyamfi-Bannerman C, Thom EA, Blackwell SC, Tita AT, Reddy UM, Saade GR, et al. Antenatal betamethasone for women at risk for late preterm delivery. NICHD maternal–fetal medicine units network. N Engl J Med. 2016;374(14):1311–20. https://doi.org/10.1056/NEJMoa1516783.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. American College of Obstetricians and Gynecologists. Practice advisory: antenatal corticosteroid administration in the late preterm period; 2016.

    Google Scholar 

  28. ACOG Practice Bulletin No. 188: Prelabor Rupture of Membranes. Clinical Management Guidelines for Obstetrician-Gynecologists. Obstet Gynecol. 2018 Jan;131(1):e1-e14. https://doi.org/10.1097/AOG.0000000000002455.

  29. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 677: Antenatal corticosteroid therapy for fetal maturation; 2016.

    Google Scholar 

  30. Sharp GC, Stock SJ, Norman JE. Fetal assessment methods for improving neonatal and maternal outcomes in preterm prelabour rupture of membranes. Cochrane Database Syst Rev. 2014;10:CD010209. https://doi.org/10.1002/14651858.CD010209.

    Article  Google Scholar 

  31. van der Heyden JL, van der Ham DP, van Kuijk S, Notten KJ, Janssen T, Nijhuis JG, et al. Outcome of pregnancies with preterm prelabor rupture of membranes before 27 weeks' gestation: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):12530. https://doi.org/10.1016/j.ejogrb.2013.06.012.

    Article  Google Scholar 

  32. Clinical Practice Guideline SOGC. Antibiotic therapy in preterm premature rupture of the membranes. J Obstet Gynaecol Can. 2009;31(9):863–7.

    Article  Google Scholar 

  33. Mercer BM, Miodovnik M, Thurnau GR, Goldenburg RL, Das AF, Ramsey RD, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA. 1997;278:989–95.

    Article  CAS  Google Scholar 

  34. Kenyon SL, Taylor DJ, Tarnow-Mordi W, ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet. 2001;357:979–88.

    Article  CAS  Google Scholar 

  35. Royal College of Obstetricians and Gynaecologists. Greentop Guideline No. 7: antenatal corticosteroids to reduce neonatal morbidity and mortality. London: RCOG; 2010.

    Google Scholar 

  36. Use of Antenatal Corticosteroids in Preterm Labour. Operational guidelines. GOI Child Health Division mohfw; 2014.

    Google Scholar 

  37. WHO Recommendations on Interventions to Improve Preterm Birth Outcomes. WHO Library Cataloguing-in-Publication Data; 2015.

    Google Scholar 

  38. Narava S, Rajaram G, Ramadevi A, Prakash GV, Mackenzie S. Prevention of perinatal group B streptococcal infections: a review with an Indian perspective. Indian J Med Microbiol. 2014;32(1):6–12. https://doi.org/10.4103/0255-0857.124286.

    Article  CAS  PubMed  Google Scholar 

  39. Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease––revised guidelines from CDC, 2010. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2010;59(RR–10):1–36.

    PubMed  Google Scholar 

  40. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG committee opinion no. 485: prevention of early-onset group B streptococcal disease in newborns. Obstet Gynecol. 2011;117(4):1019–27.

    Article  Google Scholar 

  41. Magnesium Sulfate before Anticipated Preterm Birth for Neuroprotection. Committee opinion no. 455. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2010;115:669–71.

    Article  Google Scholar 

  42. Magnesium Sulfate Use in Obstetrics. Committee Opinion No. 652. The American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine; 2016.

    Google Scholar 

  43. Mackeen AD, Seibel-Seamon J, Muhammad J, Baxter JK, Berghella V. Tocolytics for preterm premature rupture of membranes. Cochrane Database Syst Rev. 2014;2:CD007062. https://doi.org/10.1002/14651858.CD007062.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynaecology, Government Medical College, Patiala, Punjab, India

    Parneet Kaur & Surbhi Saini

Authors
  1. Parneet Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Surbhi Saini
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Civil Hospital, Mandi, Himachal Pradesh, India

    Alok Sharma

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kaur, P., Saini, S. (2020). Prelabor Rupture of Membranes. In: Sharma, A. (eds) Labour Room Emergencies. Springer, Singapore. https://doi.org/10.1007/978-981-10-4953-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4953-8_5

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4952-1

  • Online ISBN: 978-981-10-4953-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation