Early and late preterm premature rupture of membranes

The premature rupture of membranes (PROM), defined as rupture of the amniotic membranes before the onset of labor, remains a serious challenge for obstetricians, because of its high rate of comorbidity, including infection, cesarean section, and other associated problems. Preterm PROM (PPROM) (occurring before the 37 full gestational weeks), accompanied by preterm birth, is the leading cause of morbidity and mortality in the neonatal period. The etiology of PROM and PPROM is multifactorial, but there now exists abundant evidence that localized or systemic infection and/or inflammation is one of the most important causative factors. The presence of vaginal infection is reported to be associated with an increased risk for PROM and PPROM. Management of pregnant women with or at risk for PROM and PPROM is still one of the most important issues in obstetrics practice, which is codified by international guidelines and influenced by gestational age and the presence of complicating factors including clinical infection, placenta abruption, labor, or nonreassuring fetal status. Unfortunately, strategies for prevention of PROM appear to be controversial based on inconsistent supporting evidence. Therefore, it is encouraging to learn that Chandra and Sun's study published in this issue of the Journal of the Chinese Medical Association investigated this topic. The authors enrolled 714 pregnant women with third trimester PROM and PPROM (577 women with PROM, 116 with late PPROM at 32e36þ6 weeks, and 21 women with early PPROM, < 32 weeks' gestation) in the Jiangsu Province Hospital between January and December 2015, to study maternal characteristics and pregnancy outcomes. The authors found that breech presentation and history of previous cesarean section was associated with occurrence of PPROM compared to that of PROM (9.5% vs. 1.9% and 14.6% vs. 4.7%, respectively; both p < 0.01). In addition, high C-reactive protein levels and high maternal temperature were also found in the pregnant women with PPROM, suggesting that these indicate asymptomatic infection. Therefore, they suggested that this condition requires close monitoring to prevent adverse effects on pregnancy. Finally, they found that longer latency period in the PPROM group is predictable, and it is important to prolong the gestational age in PPROM patients. This study confirmed that accurate assessment of gestational age and understanding of the maternal, fetal, and neonatal