ANATOMY AND PHYSIOLOGY.

Premature rupture of membranes (PROM) occurs when the membranes (amniotic sac) rupture (break
open) before labor begins. PROM is referred to as preterm premature rupture of membranes if it
happens before 37 weeks of pregnancy (PPROM).

Pathophysiology and Clinical Presentation

Anatomy
The fetal membranes create the amniotic sac to surround the fetus and protect it from
infection. 
 Composed of 2 layers: 
o Amnion: 
 Innermost layer
 Contains amniotic fluid and fetus
o Chorion: 
 Separates amnion from maternal decidua (innermost uterine layer)
 Acts as a protective barrier
 Early in pregnancy: 2 distinct layers with the chorionic cavity between
 Later in pregnancy: Layers fuse to become a single amniochorion.
 Amniotic fluid:
o Produced primarily from fetal urine
o Allows for:
 Fetal movement → skeletal development
 Fetal breathing → lung development

Classifications of PROM
PROM is classified according to the gestational age at which it occurs and the interval
between rupture of the fetal membranes and the onset of true labour.
Preterm PROM occurs after 28 weeks of gestational age and before 37 weeks.

Term PROM occurs after 37 completed weeks of gestational age, including post-term

cases occurring after 40 weeks.

Preterm and term PROM are further divided into:

 Early PROM (less than 12 hours has passed since the rupture of fetal
membranes)
 Prolonged PROM (12 or more hours has passed since the rupture of fetal
membranes).

The major reason for classifying PROM into term, preterm, early and prolonged PROM
is for effective management decisions. The earlier the occurrence (preterm PROM) and
the longer the interval between the rupture of fetal membranes and onset of labour, the
more complications there are likely to be. We will describe the actions you should take
to manage cases of PROM in Section 17.6 of this study session. First, we discuss the
risk factors for PROM and then the complications that can result for the mother and the
fetus.