Spontaneous rupture of membranes (ROM) is a normal component of labor and delivery. Premature ROM (PROM) refers to rupture of the fetal membranes prior to the onset of labor irrespective of gestational age. Once the membranes rupture, delivery is recommended when the risk of ascending infection outweighs the risk of prematurity. When PROM occurs at term, labor typically ensues spontaneously or is induced within 12 to 24 hours. The preterm PROM is defined as PROM occurring prior to 37 weeks of gestation.
Risk Factors for Spontaneous Preterm Premature Rupture of Membranes
Maternal Factors
- Preterm premature rupture of membranes (PROM) in a prior pregnancy (recurrence risk is 16%-32% as compared with 4% in women with a prior uncomplicated term delivery)
- Antepartum vaginal bleeding
- Chronic steroid therapy
- Collagen vascular disorders (such as Ehlers-Danlos syndrome, systemic lupus erythematosus)
- Direct abdominal trauma
- Preterm labor
- Cigarette smoking
- Illicit drugs (cocaine)
- Anemia
- Low body mass index (BMI < 19.8 kg/m2)
- Nutritional deficiencies of copper and ascorbic acid
- Low socioeconomic status
- Unmarried status
Uteroplacental Factors
- Uterine anomalies (such as uterine septum)
- Placental abruption (may account for 10%-15% of preterm PROM)
- Advanced cervical dilatation (cervical insufficiency)
- Prior cervical conization
- Cervical shortening in the 2nd trimester (< 2.5 cm)
- Uterine over distention (polyhydramnios, multiple pregnancy)
- Intra-amniotic infection (chorioamnionitis)
- Multiple bimanual vaginal examinations (but not sterile speculum or transvaginal ultrasound examinations)
Fetal Factors
- Multiple pregnancy (preterm PROM complicates 7%-10% of twin pregnancies).
References:
- Freeman SW, Denoble A, Kuller JA, Ellestad S, Dotters-Katz S. Management of Preterm Premature Rupture of Membranes in the Late Preterm Period. Obstet Gynecol Surv. 2022 May;77(5):283-292. [Medline]
- Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008 Winter;1(1):11-22. [Medline]
Created Jun 05, 2025.
