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Premature rupture of membrane definition

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"Premature Rupture of Fetal Membranes"[MeSH Terms]

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ACOG prelabor rupture of membranes definition rupture before onset labor

Premature rupture of membranes (PROM) is the rupture of the amniotic membranes before the onset of labor/contractions, irrespective of gestational age.
  • Term PROM: PROM at or after 37 completed weeks.
  • Preterm prelabor rupture of membranes (PPROM): rupture before labor and before 37 completed weeks.
This wording is also reflected in ACOG’s definition of PPROM. Tintinalli’s Emergency Medicine defines PROM as membrane rupture before contractions begin (Tintinalli's Emergency Medicine: A Comprehensive Study).

What are the diagnostic criteria for PROM and PPROM?

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"Premature Rupture of Fetal Membranes"[MeSH Terms] AND diagnosis

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ACOG Practice Bulletin prelabor rupture membranes diagnosis pooling nitrazine ferning definition PPROM

Diagnostic criteria

PROM

Prelabor rupture of membranes (PROM) is diagnosed when there is rupture of the amniotic sac before the onset of labor, at any gestational age.

PPROM

Preterm prelabor rupture of membranes (PPROM) is PROM occurring before 37+0 weeks of gestation.

Confirmation of membrane rupture

Diagnosis is mainly clinical:
  1. Typical history
    • Sudden gush of clear fluid from the vagina followed by persistent watery leakage.
  2. Sterile speculum examination - preferred initial examination
    • Direct visualization of amniotic fluid leaking from the cervical os, or
    • Pooling of clear fluid in the posterior vaginal fornix.
    Either finding is generally diagnostic in the appropriate clinical setting.
  3. If findings are equivocal
    • Nitrazine pH test: amniotic fluid is alkaline and typically turns the paper blue. False positives can occur with blood, semen, bacterial vaginosis, alkaline urine, cervical mucus, or lubricant.
    • Ferning test: dried amniotic fluid shows an arborizing, fern-like crystallization pattern under microscopy.
    • Amniotic-fluid protein tests such as PAMG-1 or IGFBP-1 may be used as adjuncts when the diagnosis remains uncertain.
    • Ultrasound: oligohydramnios supports the diagnosis but does not by itself confirm PROM, because low fluid volume has other causes.
Avoid a routine digital vaginal examination until necessary, particularly in suspected PPROM, because it may increase infection risk and shorten the latency to delivery. The ACOG PROM guidance addresses diagnosis and management of both term and preterm PROM.
In short: confirmed fluid leakage/pooling on sterile speculum examination + rupture before labor = PROM; the same finding before 37 weeks = PPROM.

Timing for risk of sepsis in baby

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"premature rupture of membranes" AND neonatal sepsis

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CDC neonatal early onset sepsis prolonged rupture of membranes 18 hours risk factor

The important cutoff is prolonged rupture of membranes: ≥18 hours from rupture until birth.
At this point, the risk of early-onset neonatal sepsis rises, particularly if there are additional factors:
  • Preterm birth or PPROM
  • Maternal fever ≥38°C
  • Suspected/confirmed chorioamnionitis or intra-amniotic infection
  • Maternal GBS colonization, especially if intrapartum antibiotic prophylaxis was inadequate
  • Foul-smelling liquor, uterine tenderness, or fetal tachycardia
Early-onset neonatal sepsis usually presents within the first 72 hours after birth. The AAP identifies rupture of membranes >18 hours as a major risk factor for early-onset sepsis, along with prematurity, maternal GBS colonization, and intra-amniotic infection (AAP review).
For an exam answer: Risk of neonatal sepsis increases when the duration of membrane rupture exceeds 18 hours.
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