Preterm and premature rupture of fetal membranes

Premature rupture of fetal membranes (PRFM) is rupture of fetal membranes before onset of labor (pre-labor) and after 37 gestational weeks. Preterm premature rupture of fetal membranes (PPRFM) is rupture of fetal membranes before 37 gestational weeks. PRFM and PPRFM are associated with a significant perinatal infectious morbidity. Failure to diagnose rupture of fetal membranes (RFM) is associated with failure to implement standard management with subsequent increased perinatal infectious morbidity. Therefore, this review designed to summarize the risk factors, methods of diagnosis and management of RFM. The conventional diagnostic tests (i.e., nitrazine and fern) used to diagnose RFM have certain limitations. The amnio-dye test is the gold standard test used for diagnosing RFM, unfortunately it is an invasive test. Both the insulin-growth factor binding protein-1 (IGFBP-1) and AmniSure (placental alpha microglobulin-1) bedside tests have similar performance when used to confirm the diagnosis of RFM. Early PPRFM (< 34 gestational weeks) is managed expectantly. Late PPRFM (34-36 weeks + 6 days) is managed either by immediate delivery or expectantly after patient counselling and if there are no contraindications for the expectant management. The expectant management includes antibiotics for prevention of intra-amniotic infection, corticosteroids for acceleration of fetal lung maturity, tocolysis (in early PPRFM < 34 weeks), screening and prophylaxis for group-B streptococci. Magnesium sulfate for neuroprotection and lowering the risk of cerebral palsy if the PPRFM occurs before 32 gestational weeks. During the expectant management, both the mother and fetus should be strictly monitored for diagnosing causes which necessitate termination of the expectant managment.