Am J Perinatol 2005; 22(6): 287-297
DOI: 10.1055/s-2005-870659
REVIEW ARTICLE

Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Preterm Premature Rupture of Membranes: Perspectives Surrounding Controversies in Management

Kjersti M. Aagaard-Tillery1 , Francis S. Nuthalapaty2 , Patrick S. Ramsey2 , Kirk D. Ramin3
  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences, Salt Lake City, Utah
  • 2Division of Maternal-Fetal Medicine, Center for Research in Women’s Health, University of Alabama at Birmingham, Birmingham, Alabama
  • 3Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota
Further Information

Publication History

Publication Date:
13 July 2005 (online)

ABSTRACT

Preterm premature rupture of the membranes (PPROM) occurs in approximately 3% of all pregnancies, and accounts for one third of all preterm births. Despite its prevalence, optimal management of PPROM remains largely undefined and lacks conformity. In this article, we review the pathophysiology of PPROM, and summarize the available literature describing various management strategies in an effort to define current controversies in the management of PPROM.

REFERENCES

  • 1 Mercer B M. Preterm premature rupture of the membranes.  Obstet Gynecol. 2003;  101 178-193
  • 2 American College of Obstetricians and Gynecologists Practice Bulletin .Premature Rupture of Membranes. Washington, DC; American College of Obstetricians and Gynecologists June 1998 No. 1
  • 3 Garite T J. Management of premature rupture of membranes.  Clin Perinatol. 2001;  28 837-844
  • 4 Parry S, Strauss J F. Mechanisms of disease: premature rupture of the fetal membranes.  N Engl J Med. 1998;  338 663-670
  • 5 Meis P J, Ernest J M, Moore M L. Causes of low birth weight births in public and private patients.  Am J Obstet Gynecol. 1987;  156 1165-1168
  • 6 Goldenberg R L. The management of preterm labor.  Obstet Gynecol. 2002;  100 1020-1037
  • 7 Garite T J. Premature rupture of the membranes: the enigma of the obstetrician.  Am J Obstet Gynecol. 1985;  151 1001-1005
  • 8 Graham R L, Gilstrap III L C, Hauth J C et al.. Conservative management of patients with premature rupture of fetal membranes.  Obstet Gynecol. 1982;  59 607-611
  • 9 Capeless E L, Mead P B. Management of preterm premature rupture of membranes: lack of a national consensus.  Am J Obstet Gynecol. 1987;  157 11-12
  • 10 Cox S M, Williams M L, Leveno K J. The natural history of preterm ruptured membranes: what to expect of expectant management.  Obstet Gynecol. 1988;  71 558-562
  • 11 Schmidt W. The amniotic fluid compartment: the fetal habitat.  Adv Anat Embryol Cell Biol. 1992;  127 1-100
  • 12 Arias F, Gonzalez-Ruiz A R, Jacobson R L. Recent advances in the pathophysiology and management of preterm premature rupture of the fetal membranes.  Curr Opin Obstet Gynecol. 1999;  11 141-147
  • 13 Casey M L, MacDonald P C. Interstitial collagen synthesis and processing in human amnion: a property of the mesenchymal cell.  Biol Reprod. 1996;  55 1253-1256
  • 14 Malak T M, Ockleford C D, Bell S C et al.. Confocal immunofluorescence localization of collagen types I, III, IV, V and VI and their ultrastructural organization in term human fetal membranes.  Placenta. 1993;  14 385-406
  • 15 Casey M L, McDonald P C. Interstitial collagen synthesis and processing in human amnion: a property of the mesenchymal cells.  Biol Reprod. 1996;  55 1253-1260
  • 16 Fortunato S J, Menon R. Screening of novel matrix metalloproteinases (MMPs) in human fetal membranes.  J Assist Reprod Genet. 2002;  19 483-486
  • 17 Ferrand P E, Parry S, Sammel M et al.. A polymorphism in the matrix metalloproteinase-9 promoter is associated with increased risk of preterm premature rupture of membranes in African Americans.  Mol Hum Reprod. 2002;  8 494-501
  • 18 Fujimoto T, Parry S, Urbanek M et al.. A single nucleotide polymorphism in the matrix metalloproteinase-1 (MMP-1) promoter influences amnion cell MMP-1 expression and risk for preterm premature rupture of the fetal membranes.  J Biol Chem. 2002;  277 6296-6302
  • 19 Woods Jr J R, Plessinger M, Miller R K. Vitamins C and E: missing links in preventing preterm premature rupture of membranes?.  Am J Obstet Gynecol. 2001;  185 5-10
  • 20 McGregor J A, Lawellin D, Franco-Buff A, Todd J K, Makowski E L. Protease production by microorganisms associated with reproductive tract infection.  Am J Obstet Gynecol. 1986;  154 109-114
  • 21 Hillier S L, Martius J, Krohn M A, Kiviat N, Holmes K K, Eschenbach D A. A case-controlled study of chorioamnionic infection and histologic chorioamnionitis in prematurity.  N Engl J Med. 1988;  319 972-978
  • 22 Glasson J H, Woods W H. Immunoglobulin proteases in bacteria associated with bacterial vaginosis.  Aust J Med Lab Sci. 1988;  9 63-65
  • 23 McGregor J A, French J I, Jones W et al.. Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream.  Am J Obstet Gynecol. 1994;  170 1048-1060
  • 24 Katsura M, Ito A, Hirakawa S, Mori Y. Human recombinant interleukin 1 (alpha) increases biosynthesis of collagenase and hyaluronic acid in cultured human chorionic cells.  FEBS Lett. 1989;  244 315-318
  • 25 So T, Ito A, Sato T, Mori Y, Hirakawa S. Tumor necrosis factor-(alpha) stimulates the biosynthesis of matrix metalloproteinases and plasminogen activator in cultured human chorionic cells.  Biol Reprod. 1992;  46 772-778
  • 26 Tjugum J, Norstrom A. The influence of prostaglandin E2 and oxytocin on the incorporation of [3H]proline and [3H]glucosamine in the human amnion.  Eur J Obstet Gynecol Reprod Biol. 1985;  19 137-143
  • 27 DiBattista J A, Pelltier J P, Zafarullah M, Fujimoto N, Obata K, Martel-Pelletier J. Coordinate regulation of matrix metalloproteinases and tissue inhibitor of metalloproteinase expression in human synovial fibroblasts.  J Rheumatol Suppl. 1995;  43 123-128
  • 28 Guller S, Kong L, Wozniak R, Lockwood C J. Reduction of extracellular matrix protein expression in human amnion epithelial cells by glucocorticoids: a potential role in preterm rupture of the fetal membranes.  J Clin Endocrinol Metab. 1995;  80 2244-2250
  • 29 McLaren J, Taylor D J, Bell S C. Increased incidence of apoptosis in non-labor affected cytotrophoblast cells in term fetal membranes overlying the cervix: implications for preterm birth.  Hum Reprod. 1999;  14 2895-2900
  • 30 Allen S. Tocolytic therapy in preterm PROM.  Clin Obstet Gynecol. 1998;  41 842-848
  • 31 Johnson J W, Daikoku N H, Niebyl J R et al.. Premature rupture of membranes and prolonged latency.  Obstet Gynecol. 1981;  57 547-556
  • 32 Lewis D F, Major C A, Towers C V, Asrat T, Harding J A, Garite T J. Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.  Obstet Gynecol. 1992;  80 630-634
  • 33 Alexander J M, Mercer B M, Miodovnik M et al.. The impact of digital cervical examination on expectantly managed preterm rupture of membranes.  Am J Obstet Gynecol. 2000;  183 1003-1007
  • 34 Fanaroff A A, Wright L L, Stevenson D K et al.. Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991-1992.  Am J Obstet Gynecol. 1995;  173 1423-1431
  • 35 McGregor J A, French J I, Seo K. Antimicrobial therapy in preterm premature rupture of membranes: results of a prospective, double-blind, placebo-controlled trial of erythromycin.  Am J Obstet Gynecol. 1991;  165 632-640
  • 36 Mercer B M, Arhheart K L. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes.  Lancet. 1995;  346 1271-1279
  • 37 Mercer B M, Miodovnik M, Thurnau G R et al.. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes.  JAMA. 1997;  278 989-995
  • 38 Kenyon S L, Taylor D J, Tarnow-Mordi W et al.. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomized trial.  Lancet. 2001;  357 979-988
  • 39 Leveno K J, Cox K, Roark M L. Cervical dilatation and prematurity revisited.  Obstet Gynecol. 1986;  68 434-435
  • 40 National Institutes of Health Consensus Development Panel .Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH publication No. 95-3784. Bethesda, MD; National Institute of Child Health and Human Development November 1994
  • 41 Garite T J, Keegan K A, Freeman R K, Nageotte M P. A randomized trial of ritodrine tocolysis versus expectant management in patients with premature rupture of membranes at 25 to 30 weeks of gestation.  Am J Obstet Gynecol. 1987;  157 388-393
  • 42 Weiner C P, Renk K, Klugman M. The therapeutic efficacy and cost effectiveness of aggressive tocolysis for premature labor associated with premature rupture of the membranes.  Am J Obstet Gynecol. 1988;  159 216-222
  • 43 Mercer B M, Crocker L G, Boe N M, Sibai B M. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial.  Am J Obstet Gynecol. 1993;  169 775-782
  • 44 Cox S M, Leveno K J. Intentional delivery versus expectant management with preterm ruptured membranes at 30-34 weeks gestation.  Obstet Gynecol. 1995;  86 875-879
  • 45 Naef R W, Albert J R, Ross E L, Weber B M, Martin R W, Morrison J C. Premature rupture of membranes at 34 to 37 weeks gestation: aggressive versus conservative management.  Am J Obstet Gynecol. 1998;  178 126-130
  • 46 Mercer B M, Goldenberg R L, Moawad A H et al.. The Preterm Prediction Study: effect of gestational age and cause of preterm birth on subsequent obstetric outcome.  Am J Obstet Gynecol. 1999;  181 1216-1221
  • 47 Ramsey P S, Nuthalapaty F S, Lu G, Ramin S, Nuthalapaty E S, Ramin K D. Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers.  Am J Obstet Gynecol. 2004;  191 1497-1502
  • 48 Nuthalapaty F S, Ramsey P S, Lu G, Ramin S M, Nuthalapaty E S, Ramin K D. Contemporary management of PPROM: does practice setting make a difference?.  Am JObstet Gynecol. 2003;  198 S176
  • 49 Yoon B H, Jun J K, Romero R et al.. Amniotic fluid inflammatory cytokines (interleukin 6, interleukin 1B, and tumor necrosis factorα), neonatal brain white matter lesions, and cerebral palsy.  Am J Obstet Gynecol. 1997;  177 19-26
  • 50 Yoon B H, Romero R, Park J S, Kim C J, Choi J H, Han T R. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years.  Am J Obstet Gynecol. 2000;  182 675-681
  • 51 Vigneswaran R. Infection and preterm birth: evidence of a common causal relationship with bronchopulmonary dysplasia and cerebral palsy.  J Paediatr Child Health. 2000;  36 293-296
  • 52 Nelson K B, Ellenberg J H. Antecedents of cerebral palsy: multivariate analysis of risk.  N Engl J Med. 1986;  315 81-86
  • 53 Gaudet L M, Smith G N. Cerebral palsy and chorioamnionitis: the inflammatory cytokine link.  Obstet Gynecol Surv. 2001;  56 433-436
  • 54 Wu Y W, Colford Jr J M. Chorioamnionitis as a risk factor for cerebral palsy: a meta-analysis.  JAMA. 2000;  284 1417-1424
  • 55 Crowley P. Prophylactic corticosteroids for preterm birth.  Cochrane Database Syst Rev. 2000;  2 , CD000065
  • 56 Crowley P A. Antenatal corticosteroid therapy: a meta-analysis of randomized trials, 1972 to 1994.  Am J Obstet Gynecol. 1995;  173 322-335
  • 57 Morales W J, Diebel D, Lazar A J, Zadrozny D. The effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome in preterm gestations with premature rupture of membranes.  Am J Obstet Gynecol. 1986;  154 591-595
  • 58 Effect of corticosteroids for fetal maturatin on perinatal outcomes.  NIH Consens Statement. 1994;  12 1-24
  • 59 Gardner M O, Papile L A, Wright L L. Antenatal corticosteroids in pregnancies complicated by preterm premature rupture of membranes.  Obstet Gynecol. 1997;  90 851-853
  • 60 Imseis H M, Iams J D. Glucocorticoid use in patients with preterm premature rupture of the fetal membranes.  Semin Perinatol. 1996;  20 439-450
  • 61 Vermillion S T, Soper D E, Bland M L, Newman R B. Effectiveness of antenatal corticosteroid administration after preterm premature rupture of the membranes.  Am J Obstet Gynecol. 2000;  183 925-929
  • 62 Pattinson R C, Makin J D, Funk M et al.. The use of dexamethasone in women with preterm premature rupture of membranes: a multicentre, double-blind, placebo-controlled, randomized trial. Dexiprom Study Group.  S Afr Med J. 1999;  89 865-870
  • 63 Harding J E, Pang J-M, Knight D B, Liggins G C. Do antenatal corticosteroids help in the setting of preterm rupture of membranes?.  Am J Obstet Gynecol. 2001;  184 131-139
  • 64 Liggins G C, Howie R N. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants.  Pediatrics. 1972;  50 515-525
  • 65 Banks B A, Cnaan A, Morgan M A et al.. Multiple courses of antenatal corticosteroids and outcome of premature neonates.  Am J Obstet Gynecol. 1999;  181 709-717
  • 66 Thorp J A, Jone A M, Hunt C, Clark R. The effect of multidose antenatal betamethasone on maternal and infant outcomes.  Am J Obstet Gynecol. 2001;  184 196-202
  • 67 Lee M-J, Davies J, Guinn D et al.. Single versus weekly courses of antenatal corticosteroids in preterm premature rupture of membranes.  Obstet Gynecol. 2004;  103 274-281
  • 68 Simchen M J, Alkazaleh F, Adamson S L et al.. The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction.  Am J Obstet Gynecol. 2004;  190 296-304
  • 69 Christensen K K, Ingemarsson I, Leideman T, Solum T, Svenningsen N. Effect of ritodrine on labor after premature rupture of the membranes.  Obstet Gynecol. 1980;  55 187-190
  • 70 Levy D L, Warsof S L. Oral ritodrine and preterm premature rupture of membranes.  Obstet Gynecol. 1985;  66 621-623
  • 71 Wapner for the NICHD MFMU Network . A randomized trial of single vs weekly courses of corticosteroids.  Am J Obstet Gynecol. 2003;  189 S56
  • 72 Guinn D A, Atkinson M W, Sullivan L et al.. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: a randomized controlled trial.  JAMA. 2001;  286 1581-1587
  • 73 National Institutes of Health (NIH) Consensus Statement . Antenatal corticosteroids revisited: repeat courses.  NIH Consens Statement. 2000;  17 1-18
  • 74 Matsuda Y, Ikenoue T, Hokanishi H. Premature rupture of the membranes-aggressive versus conservative approach: effect of tocolytic and antibiotic therapy.  Gynecol Obstet Invest. 1993;  36 102-107
  • 75 Mercer B, Moretti M, Rogers R, Sibai B. Antibiotic prophylaxis in preterm premature rupture of membranes: prospective randomized double-blind trial of 220 patients.  Am J Obstet Gynecol. 1992;  166 794-802
  • 76 American College of Obstetricians and Gynecologists . ACOG practice bulletin number 47, October 2003: Prophylactic antibiotics in labor and delivery.  Obstet Gynecol. 2003;  102 875-882
  • 77 Andrews W W, Goldenberg R L, Hauth J C. Preterm labor: emerging role of genital tract infections.  Infect Agents Dis. 1995;  4 196-211
  • 78 Goldenberg R L, Hauth J C, Andrews W W. Intrauterine infection and preterm delivery.  N Engl J Med. 2000;  342 1500-1507
  • 79 Yoon B H, Romero R, Yang S H et al.. Interleukin-6 concentrations in umbilical cord plasma are elevated in neonates with white matter lesions associated with periventricular leukomalacia.  Am J Obstet Gynecol. 1996;  174 1433-1440
  • 80 Jobe A H, Ikegami M. Mechanisms initiating lung injury in the preterm.  Early Hum Dev. 1998;  53 81-94
  • 81 American College of Obstetricians and Gynecologists . ACOG committee opinion number 279, December 2002: prevention of early-onset group B streptococcal disease in newborns.  Obstet Gynecol. 2002;  100 1405-1412
  • 82 Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC.  MMWR Recomm Rep. 2002;  51 1-22
  • 83 Matteson J J, Ramsey P S, Brumfield C G, Carlo W. Preterm premature rupture of membranes: is there an optimal delivery gestational age?.  Obstet Gynecol. 2002;  99 74S-75S

Kirk D RaminM.D. 

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Minnesota

420 Delaware Street SE, Minneapolis, MN 55455

    >