Published: 2020-11-26

Pregnancy outcome in preterm premature rupture of membranes between 24 to 34 weeks of gestation

Sujatha Venkatraman, Latha Chaturvedula, Subhash Chandra Parija


Background: Preterm premature rupture of membranes (PPROM) is spontaneous rupture of the fetal membranes before 37 completed weeks and before onset of labour which complicates 3-5% of all pregnancies. Studies regarding PPROM in very early gestation are lacking. The primary objective was to assess the maternal and perinatal outcome in preterm premature rupture of membranes and secondary objective was to assess the colonization of group B Streptococci (GBS) and Listeria monocytogenes in patients with PPROM.

Methods: This prospective study was performed on 175 antenatal women with PPROM between 24 to 34 weeks of gestation.

Results: Majority of women (54.2%) were between 32 to 34 weeks of gestation, 37% were between 28 to 32 weeks of gestation and 7.8% were between 24 to 28 weeks of gestation. About 22 % of women had cervicovaginal infections. The prevalence of group B Streptococci in the study group was 1.2% and no isolates of Listeria. The most common maternal morbidity was puerperal fever (11.4 %). Among newborn babies 87 (55 %) required neonatal intensive care unit (NICU) admission mainly for respiratory distress and prematurity. With each week of increase in gestational age, there is decrease in latency period by 22 hours and duration of NICU stay nearly by one day.

Conclusions: From the present study it may be concluded that PPROM is associated with genitourinary infection, puerperal pyrexia and respiratory distress syndrome among neonates. The prevalence of group B Streptococci in antenatal women with PPROM is very low and no Listeria were isolated.


Group B Streptococci, Listeria monocytogenes, Preterm premature rupture of membranes, Puerperal pyrexia, Respiratory distress syndrome

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Merser BM. Premature Rupture of the Membranes. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th edition. Philadelphia, PA: Elsevier Saunders; 2012:659-72.

Manuck TA, Maclean CC, Silver RM, Varner MW. Preterm premature rupture of membranes: Does the duration of latency influence perinatal outcomes? Am J Obstet Gynecol. 2009;201:414.e1-6.

Mc Gregor JA, French JI, Parker R, Draper D, Patterson E, Jones W, et al. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol. 1995;173(1):157-67.

Centers for disease Control and Prevention. Morbidity and Mortality Weekly Report: Prevention of Perinatal Group B Streptococcal disease. 2010;59(RR-10):1-32. Available at Accessed 8 March 2014.

Janakiraman V. Listeriosis in pregnancy: diagnosis, treatment, and prevention. Rev Obstet Gynecol. 2008;1(4):179-85.

Silveira ML, Caminha NO, Sousa RA, Pessoa, SM, Gurgel EP, Cavalcante DM. Neonatal outcome in pregnancies that presented premature rupture of membranes. Rev Rene. 2014;15(3):491-8.

Galletta MAK, Bittar RE, Agra I, Guerra ECL, Francisco RPV, Zugaib M. Epidemiological profile of patients with preterm premature rupture of membranes at a tertiary hospital in São Paulo, Brazil. Clinics (Sao Paulo). 2019;74.e1231.

Kilpatrick SJ, Patil R, Connell J, Nichols J, Studee L. Risk factors for previable premature rupture of membranes or advanced cervical dilation: a case control study. Am J Obstet Gynecol. 2006;194(4):1168-75.

Getahun D, Strickland D, Ananth CV, Fassett MJ, Sacks DA, Kirby RS, et al. Recurrence of preterm premature rupture of membranes in relation to interval between pregnancies. Am J Obstet Gynecol. 2010;202(6):570.e1-6.

Mercer B. Antibiotics in the management of PROM and preterm labour. Obstet Gynecol Clin N Am. 2012;39(1):65-76.

Goya M, Bernabeu A, García N, Plata J, Gonzalez F, Merced C, et al. Premature rupture of membranes before 34 weeks managed expectantly: maternal and perinatal outcomes in singletons. J Matern Fetal Neonat Med. 2013;26(3):290-3.

Paramel Jayaprakash T, Wagner EC, van Schalkwyk J, Albert AY, Hill JE, Money DM. High diversity and variability in the vaginal microbiome in women following preterm premature rupture of membranes (PPROM): a prospective cohort study. PLoS One. 2016;11(11):e0166794.

Granados CG, Echevarría LN, Méndez NI, Maresca MI, Martínez MA, Aragón JA. Preterm premature rupture of membranes and neonatal outcome prior to 28 weeks of gestation. Prog Obstet Gynecol. 2009;52(3):151-9.

Zhang LX, Sun Y, Zhao H, Zhu N, Sun XD, Jin X, et al. A Bayesian stepwise discriminant model for predicting risk factors of preterm premature rupture of membranes: a case-control study. Chin Med J. 2017;130(20):2416-22.

Nomura ML, Passini Júnior R, Oliveira UM, Calil R. Group B streptococcus maternal and neonatal colonization in preterm rupture of membranes and preterm labour. Rev Bras Ginecol Obstet. 2009;31(8):397-403.

Coughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol. 2008;1(1):11-22.

Hughes RG, Brocklehurst P, Steer PJ, Heath P, Stenson BM. Prevention of early-onset neonatal group B streptococcal disease. Green-top Guideline No. 36. BJOG. 2017;124:e280-305.

Thomson AJ, Royal College of Obstetricians and Gynaecologists. Care of women presenting with suspected preterm prelabour rupture of membranes from 24+0 weeks of gestation. BJOG. 2019;126:e152-66.

Gonçalves LF, Silveira SK, Saab Neto JA. Descriptive study on the antibiotic profilaxy at preterm premature rupture of membranes. Arq Catarin Med. 2009;38(2):67-72.

Palmer L, Grabowska K, Burrows J, Rowe H, Billing E, Metcalfe A. A retrospective cohort study of hospital versus home care for pregnant women with preterm prelabour rupture of membranes. Int J Gynaecol Obstet. 2017;137(2):180-4.

Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003;101(1):178-93.

Alexander JM, Mercer BM, Miodovnik M, Thurnau GR, Goldenberg RL, Das AF, et al. The impact of digital cervical examination on expectantly managed preterm rupture of membranes. Am J Obstet Gynecol. 2000;183(4):1003-7.