DefinitionTerm premature rupture of membranes (PROM) : rupture of membranes before onset of labor8-10% of all pregnancies

Preterm premature rupture of membranes (pPROM) : rupture of membranes

EtiologyMultifactorialOverdistend the uterus :Multiple gestationPolyhydramniosCollagenolytic activity and collagen solubility Collagen DeficiencyInfectionPlacenta abruption Incompetence cervix

Risk FactorBlack peopleLow socioeconomic statusSmokingLow BMI

MechanismsIntra partum rupture of fetal membranes caused by generalized weakening - uterine contractions- repeated stretching

Premature rupture of membranes can be caused by :Changes in collagen content, structure and catabolismChanges in the membranes (collagen content, altered collagen structure, collagenolytic activity) premature rupture of the membranes

MechanismsConnective-Tissue Disorders and Nutritional Deficiencies Risk factor Connective-tissue disorders weakened fetal membranes incidence of PROMNutritional deficiencies abnormal collagen structure, copper concentrations in maternal and umbilical-cord serum, serum concentrations of ascorbic acid risk of PROM

MechanismsIncreased Collagen DegradationDegradation of Collagen is mediated by matrix metalloproteinase (MMP) which are inhibited by spesific tissue inhibitor and other protease inhibitorBalance of MMP and TIMP-1 proteolytic degradation of extracellular matrix of the fetal membranes. Imbalance between MMP and TIMP-1 degradation of the membranes s extracellular matrix PROM Periodontal disease MMP in gingival tissue PROM

ComplicationsPremature Rupture of Membranes causes oligohydramnios which will lead to : Fetal Deformity Syndrome due to fetal compression Hypoxia and asfixia due to cord compressionInfection Increase in Pre-term Premature Rupture of MembranesMaternal : Chorioamnionitis Fetal: septicemia, pneumonia, omphalitisPremature delivery, which increases the risk of respiratory distress and infection

Fetal Membranes is strong at early pregnancy, at third trimester fetal membranes easily rupture, because of :Distended the uterusContraction of uterusMovement of fetalChanging of biokimia of fetal membranes *PROM is diagnosed by the occurrence of any 2 of the following:o Pooling of fluid in the vaginal vaulto Positive Nitrazine testo Ferning of vaginal fluid

Management depends on the GA at the time of confirmation of the diagnosis of rupturedmembranes. At all gestational ages, expectant management is associated with a risk of ascending infection and umbilical cord compression, therefore the risks of expectant management must be balanced against the risks of immediate delivery.

*Kortikosteroid : The most widely used and recommended regimens include intramuscular betamethasone 12 mg every 24 hours for two days, orintramuscular dexamethasone 6 mg every 12 hours for two dayCorticosteroids should be given to patients with preterm PROM between 24 and 32 weeks gestation to decrease the risk of intraventricular hemorrhage, respiratory distress syndrome, and necrotizing enterocolitis.

Antibiotiik : The regimen studied by the National Institute of Child Health and Human Development uses an intravenous combination of 2 grams of ampicillin and 250 mg of erythromycin every six hours for 48 hours, followed by 250 mg of amoxicillin and 333 mg of erythromycin every eight hours for five days.Antibiotics should be administered to patients with preterm PROM because they prolong the latent period and improve outcomes.*These patients should be referred to a tertiary center for counseling and management. Facilities capable of providing the appropriate level of neonatal resuscitative and supportive care commensurate with the gestational age.

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