Determinants of favourable neonatal outcome after premature rupture of membranes (PROM) before 24 weeks of pregnancy – review of the literature and a case report
More details
Hide details
Department of Mother’s and Child’s Health, University of Medical Sciences, Poznan, Poland
Department of Chemical Technology of Drugs, University of Medical Sciences, Poznan, Poland
Ann Agric Environ Med. 2012;19(3):577–580
Premature rupture of the membranes (PROM) in pregnancy refers to rupture of membranes of the amniotic sac and chorion. The aim of the study was to review the literature and analyze the course of pregnancy (primipara) complicated by the premature rupture of the membranes, and consequent loss of amniotic fluid after 19 weeks of gestation.

Study design:
A 27-year old primiparous patient was admitted to the Gynaecology and Obstetrics University Hospital in Poznań on 9 December 2010, due to suspected premature rupture of the membranes. On presentation, foetal development was at 19 weeks gestation. Standard clinical investigations included ultrasonography, amniotic fluid index measurements and laboratory blood tests.

Ultrasonography confirmed the size of the foetus to be normal for the gestational age. However, no amniotic fluid pockets were visible and the amniotic fluid index was 0 cm. The patient was hospitalized on multiple occasions and as a result a decision was made to end the pregnancy prematurely by means of a caesarean section at 32 weeks of gestation. Longer-term observation of the newborn indicated that one year following delivery, the development of the baby was normal, and thus far no neurological injuries or complications have been observed.

The pregnancy was ultimately successfully completed with the delivery of a healthy newborn at 32 weeks of gestation. A regime involving rigorous bed rest and antibiotic administration can positively extend the duration of pregnancies complicated by premature rupture of the membranes.

The authors wish to especially thank the parents concerned for their permission to publish the photos of their son, Michałek, and the entire team of healthcare professionals for the care they provided to the patient and the newborn. The authors also thank the Proper Medical Writing (infrared group s.c.) for language assistance in the preparation of this paper.
Dinsmoor MJ, Bachman R, Haney EI, Goldstein M, MackKendrick W. Outcomes after expectant management of extremely preterm premature rupture of the membranes. Am J Obstet Gynecol. 2004; 190: 183-7.
Hoekstra RE, Ferrara TB, Couser RJ, Payne NR, Connett JE. Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23-26 weeks’ gestational age at a tertiary center. Pediatrics. 2004; 113: 1-6.
ACOG committee on practice bulletins-obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. 2007; 109: 1007-19.
Kopyra P, Seremak-Mrozikiewicz A, Drews K. Usefulness of PCT, IL-6, CRP measurement in the prediction of intraamniotic infection and newborn status in pregnant women with premature rupture of membranes. Ginekol Pol. 2010; 81: 336-41.
Spitz B, Vossen C, Devlieger R, Van Assche FA. Rupture of membranes before 26 weeks of gestation: outcome of 148 consecutive cases. J Perinat Med. 1999; 27: 451-7.
Falk SJ, Campbell LJ, Lee-Parritz A, et al. Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks› gestation. J Perinat. 2004; 24: 611-6.
Copper RL, Goldenberg RL, Creasy RK, et al. A multicenter study of preterm birth weight and gestational age-specific neonatal mortality. Am J Obstet Gynecol. 1993; 168: 78-84.
Kenyon S, Boulvain M, Neilson J. Antibiotic for preterm rupture of the membranes: A systematic review. Obstet and Gynecol. 2004; 104: 1051-7.
Lamont RF. The prevention of preterm birth with the use of antibiotics. Eur J Pediatr. 1999; 158: S2-4.
Yudin MH, Van Schalkwyk J, Van Eyk N. Antibiotic therapy in preterm premature rupture of membranes. J Obstet Gynaecol Can. 2009; 31: 863-74.
Hadi HA, Hodson CA, Strickland D. Premature rupture of the membranes between 20 and 25 week’ s gestation: role of amniotic fluid volume in perinatal outcome. Am J Obstet Gynecol. 1994; 1139-44.
Verma U, Goharkhay N, Beydoun S. Conservative management of preterm premature rupture of membranes between 18 and 23 weeks of gestation-maternal and neonatal outcome. Eur J Obstet Gynecol Reprod Biol. 2006; 128: 119-24.
Muris C, Girard B, Creveuil C, Durin L, Herlicoviez M, Dreyfus M. Management of premature rupture of membranes before 25 weeks. Eur J Obstet Gynecol Reprod Biol. 2007; 131: 163-8.
Halima T. Premature rupture of membranes at week 19: favorable pregnancy outcome and four years follow-up after expectant management. Int J Gynaecol Obstet. 2010; 14 (2).
Kazimierak W, Karowicz-Bilinska A, Berner-Trabska M. Pregnancy in primigravida complicated by premature rupture of membranes in 15th weeks of pregnancy with successful delivery outcome of the mature newborn – case report. Ginekol Pol. 2006; 77: 310-3.