Prelabour rupture of the membranes: recent evidence

Premature rupture of the membranes (PROM) complicates 10% of all gestations and 2-4% of preterm pregnancy. Our success in preventing preterm PROM and preterm birth is hampered by our limited knowledge of its etiology. PROM remains the single most identifiable cause of preterm delivery and the major contributor to perinatal morbidity and mortality. Its clinical management continues to be controversial. The management dilemma associated with preterm PROM (PPROM) involves a balance between expectant management and intervention, taking into consideration the risks of infection with the increased duration of membrane rupture. Recent evidence on the use of antibiotics and amnioinfusion, together with advances in the prediction, diagnosis and estimation of risk based upon occupational factors and genetics have provided additional therapeutic tools in our approach to the problem of PPROM. While PPROM at very early gestation is a serious complication and a major management dilemma often associated with poor outcome, the prognosis is not without hope.