Premature rupture of the membranes: diagnostic and management strategies

Premature rupture of the membranes is associated with considerable neonatal and maternal morbidity when it leads to premature birth. In most cases, this condition occurs at term, does not require medical intervention and has a benign course. Although few effective preventive measures are available, the family physician should screen pregnant patients for remediable risk factors, including smoking and certain vaginal infections, such as trichomoniasis. Diagnostic strategies include assessment of the amniotic fluid and laboratory tests to evaluate fetal and maternal welfare. Management options include expectant treatment, induction of labor or initiation of corticosteroids, antibiotics and/or tocolytics. These options must be carefully evaluated because of the morbidity associated with prematurity and the increased incidence of sepsis in prolonged rupture of the membranes.