Premature rupture of the membranes in term patients

Premature rupture of the membranes (PROM) occurs in 5-10% of pregnancies. Approximately 60% of cases are in term patients. Infection of the lower genital tract and/or amniotic cavity is one of the most important etiologies of PROM. The diagnosis is usually established by direct observation of pooling of amniotic fluid in the vaginal vault. In problematic cases, the nitrazine and fern tests can be used to confirm the diagnosis. Term patients with PROM and favorable cervices should undergo induction of labor with oxytocin. Patients with unfavorable cervices probably are best managed by induction of labor with prostaglandin compounds, although, in highly selected cases, expectant management may be considered. During induction of labor, long latent phases should be anticipated, and vaginal examinations should be minimized. Patients should receive prophylactic antibiotics, if indicated, for prevention of group B streptococcal infection and should be observed carefully for early signs of chorioamnionitis.