CHAPTER I

INTRODUCTION

Preterm labor is defined as regular contraction of the uterus resulting in

changes in the cervix that start before 37 weeks of pregnancy. 1,2 Changes in the cervix
include effacement (the cervix thins out) and dilation (the cervix opens so that the
ferus can enter the birth canal). In some cases preterm labor can lead to a baby being
born too soon. Premature Rupture of Membrane (PROM) is defined as rupture of
membranes with labor contractions before 37 completed weeks of gestation. 1,2 When
membrane rupture occurs before labor and before 37 weeks of gestation, it is referred
to as preterm PROM (PPROM).1,2 The prevalence of PROM is quites large and tends
to increase It typically is associated with brief latency between membrane rupture and
delivery, increased risk of perinatal infection, and in utero umbilical cord
compression. Preterm PROM complicates approximately 3% of pregnancies and
leads to one third of preterm birth. It increases the risk of prematurity and leads to a
number of other perinatal of neonatal complication, including a 1 to 2 percent risk of
fetal death. It can lead to significant fetal perinatal morbidity such as respiratory
distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption and
fetal death.1-3 The risk for premature rupture of membranes in nulliparous women is
hard to indentify. In multiparous women the behavior in past pregnancies is the best
predictor of possible risk. Numerous risk factors are associated with preterm PROM.
Black patients are at increased risk of preterm PROM compared with white patients.
Other patients at higher risk include those who have lower socioeconomic status, are
smokers, have a history of sexually transmitted infections, have had a previous
preterm delivery, have vaginal bleeding, or have uterine distension (e.g.,
polyhydramnios, multifetal pregnancy)