Etiology, Management, and Maternal and Neonatal Outcomes of Pregnancies Complicated by Premature Rupture of Membranes

Dear Colleagues,

Premature rupture of membranes (PROM) is defined as the loss of the integrity of the chorioamniotic membranes prior to the onset of labor. The occurrence of PROM ranges between 5–15% of all pregnancies worldwide depending on the demographic characteristics of the population studied. When the fetal membrane rupture takes place prior to labor and before 37 weeks of pregnancy, it is referred to as preterm PROM (PPROM). This obstetric disorder complicates 3–5% of pregnancies and is the most identifiable leading cause of preterm birth, with one-third of preterm deliveries being the consequence of PPROM. Previable PPROM, which is the spontaneous rupture of gestational membranes near or before the fetal viability limit at 24^0/7 weeks of gestation, complicates less than 1% of all pregnancies with a reported incidence of 3.7/1000 pregnancies and represents a devastating pregnancy complication with high maternal and fetal adverse outcomes.

PROM is considered a disease of fetal membranes. Membrane rupture may occur for a variety of reasons that induce accelerated membrane weakening through an imbalance between the pro-inflammatory and anti-inflammatory cytokine production. This results in an activation of different humoral and cellular immunologic components, including an increase in the production of prostaglandins and local cytokines, and the activation of matrix-degrading proteases that lyse collagen. Clinical outcomes of premature membrane rupture are associated with a brief latency from membrane rupture to labor, infectious complications, and adverse neonatal outcomes associated with preterm delivery. Neonates who experienced PPROM are at high risk of perinatal morbidity and mortality, which is mainly due to prematurity along with the risks associated with the presence of prolonged oligohydramnios, umbilical cord prolapse, perinatal infection, umbilical cord compression, and in utero fetal demise. Therefore, it is crucial to ascertain the mechanisms involved in PPROM and develop novel treatments and strategies to prevent or manage this entity.

Assoc. Prof. Dr. Süleyman Cemil Oğlak

Guest Editor

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