Approximately 250,000 live births in the United States each year are complicated by premature rupture of the membranes (PROM). Approximately 40,000 of these births are before term. It is an unpredictable event that is not well understood. PROM is defined as the rupture of membranes before the onset of labor. It is frequently a complicating factor in the management of both term and preterm pregnancies.Within 1 week after the occurrence of PROM in a preterm pregnancy, 90 of the patients will be delivered. Within 24 hours after the occurrence of PROM in a term pregnancy, 90 of patients will be delivered. The incidence of dysfunctional labor, chorioamnionitis, cesarean delivery, postpartum hemorrhage, endomyometritis, and neonatal infection is higher in preterm and term gestations if not managed appropriately.1Up to 30 of all preterm births are directly associated with PROM. In cases of prolonged PROM, when labor does not ensue, the fetus is at risk for structural and developmental anomalies, especially when PROM occurs before 23 weeks estimated gestational age.2-5In today's era of improved neonatal survival and higher expectations for intact infant survival at very early gestational ages, more patients with preterm PROM are being cared for in hospitals. Intervention aimed at remediating the cause of PROM in many cases includes antibiotics.6-8Intervention aimed at treating the consequences of prolonged PROM in some cases includes intrauterine saline infusion (amnioinfusion).9Unfortunately, such interventions have met with only limited success. Therefore, prevention, as in all areas of medicine, should be the proper focus of the patient's physician.
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