PPROM

PPROM occurs when the amniochorionic membranes rupture before 37 weeks' gestation and before labor begins, distinguishing it from PROM (rupture at term) and from preterm labor with intact membranes. Etiology is multifactorial, often related to subclinical intrauterine infection/inflammation, which weakens membrane integrity via matrix metalloproteinase activity, but risk factors also include prior PPROM, short cervix, multiple gestation, smoking, and vaginal bleeding. Diagnosis is clinical: sterile speculum exam showing pooling of fluid, positive nitrazine (pH) test, ferning pattern on microscopy, or vaginal fluid biomarkers (e.g., PAMG-1, IGFBP-1) when exam is equivocal. Ultrasound may show oligohydramnios supporting diagnosis. Digital cervical exam should be avoided unless delivery is imminent, due to infection risk. Complications include chorioamnionitis, placental abruption, umbilical cord prolapse or compression, fetal pulmonary hypoplasia (if very early and prolonged oligohydramnios), and neonatal sepsis. Management depends on gestational age: at ≥34 weeks, delivery is generally recommended; between 24-33 6/7 weeks, expectant management with antenatal corticosteroids (to accelerate fetal lung maturity), latency antibiotics (e.g., ampicillin + azithromycin/erythromycin) to prolong pregnancy and reduce infection, and magnesium sulfate for neuroprotection (<32 weeks) is standard. GBS prophylaxis is given during labor per standard protocols. Close monitoring for signs of infection (maternal fever, tachycardia, uterine tenderness, fetal tachycardia) and fetal well-being (NSTs, biophysical profiles) is essential during expectant management. Delivery is expedited if chorioamnionitis, abruption, nonreassuring fetal status, or labor develops.