Preterm prelabour rupture of membranes

A 29-week woman rings the birth suite: "I think my waters have broken." She is not contracting, she has no pain and no bleeding, and she feels completely well. Everything you do in the next twenty minutes is either a diagnosis you can make safely or an infection you can cause. The speculum earns its place here more than anywhere else in obstetrics.^[1][10]

Overview and definition

PPROM is spontaneous rupture of the fetal membranes before 37+0 weeks and before labour starts. It precedes roughly a third of preterm births and it converts a sterile compartment into a colonised one, which is why the whole topic is a negotiation between prematurity and infection.^[1][5]

The clinical bands that change management: ^[1][9][6]

• Previable (before about 23 to 24 weeks): the conversation dominates the medicine — pulmonary hypoplasia, contractures, prolonged inpatient stay, and outcomes that vary widely between centres.^[17][9]
• Early preterm (24 to 33+6): the classical package — latency antibiotics, corticosteroids, magnesium if birth is early and imminent, and surveillance.^[1][12]
• Late preterm (34 to 36+6): the PPROMT question — expectant management with surveillance rather than automatic immediate birth.^[6]

References18ShowHide

1. [1]Thomson AJ Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24(+0) Weeks of Gestation: Green-top Guideline No. 73 BJOG, 2019.PMID 31207667
2. [2]Kenyon SL, Taylor DJ, Tarnow-Mordi W Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial Lancet, 2001.PMID 11293640
3. [3]Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial Lancet, 2008.PMID 18804274
4. [4]Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial JAMA, 1997.PMID 9307346
5. [5]Kenyon S, Boulvain M, Neilson JP Antibiotics for preterm rupture of membranes Cochrane Database Syst Rev, 2013.PMID 24297389
6. [6]Morris JM, Roberts CL, Bowen JR, Patterson JA, Bond DM, et al. 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.PMID 26564381
7. [7]Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA, et al. 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, 2017.PMID 28257562
8. [8]Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, et al. Evaluation and Management of Women and Newborns With a Maternal Diagnosis of Chorioamnionitis: Summary of a Workshop Obstet Gynecol, 2016.PMID 26855098
9. [9]American College of Obstetricians and Gynecologists Obstetric Care consensus No. 6: Periviable Birth Obstet Gynecol, 2017.PMID 28937572
10. [10]American College of Obstetricians and Gynecologists Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217 Obstet Gynecol, 2020.PMID 32080050
11. [11]McGoldrick E, Stewart F, Parker R, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2020.PMID 33368142
12. [12]Stock SJ, Thomson AJ, Papworth S, et al. Antenatal corticosteroids to reduce neonatal morbidity and mortality: Green-top Guideline No. 74 BJOG, 2022.PMID 35172391
13. [13]Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus Cochrane Database Syst Rev, 2024.PMID 38726883
14. [14]Mackeen AD, Seibel-Seamon J, Muhammad J, Baxter JK, Berghella V Tocolytics for preterm premature rupture of membranes Cochrane Database Syst Rev, 2014.PMID 24578236
15. [15]Seaman RD, Kopkin RH, Turrentine MA Erythromycin vs azithromycin for treatment of preterm prelabor rupture of membranes: a systematic review and meta-analysis Am J Obstet Gynecol, 2022.PMID 34973176
16. [16]Bouchghoul H, Kayem G, Schmitz T, Benachi A, Sentilhes L, et al. Outpatient versus inpatient care for preterm premature rupture of membranes before 34 weeks of gestation Sci Rep, 2019.PMID 30862787
17. [17]Grill A, Mikula F, Jansen S, Klein L, Rittenschober-Boehm J, et al. Neonatal outcomes following previable rupture of membranes below 23 weeks' gestation Eur J Pediatr, 2025.PMID 40711593
18. [18]Gordon HG, Shub A, Stewart MJ, Kane SC, Cheong JL, et al. In-utero transfer, survival-focused care and survival to 28-days at 22-24 weeks' gestation pre- and post- implementation of an extreme prematurity management guideline in Victoria, Australia BMJ Paediatr Open, 2024.PMID 39433430