PRETERM PREMATURE RUPTURE OF MEMBRANES IN FULL-TERM PREGNANCY: A RETROSPECTIVE ANALYSIS OF OBSTETRIC AND PERINATAL OUTCOMES
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Abstract
The incidence of PROM (premature rupture of membranes) in full-term pregnancies is 19.6%. PROM increases the risk of complications during labor and the postpartum period, and it reoccurs in every third to fourth birth. In full-term pregnancies, labor progresses spontaneously within 24 hours in 90% of cases. Clinical guidelines for rational management of patients with PROM, as well as determining the optimal waiting period, are lacking, especially in cases of unpreparedness and increasing anhydrous period. This makes the problem of PROM relevant and prompts the search for solutions.
The purpose of the study – to analyze obstetric and perinatal outcomes of births in pregnant women with PROM, delivered in the obstetric hospital N 2 of the perinatal center of the City Clinical Hospital N 1 named after G.P. Kurbatov for 6 months of 2024.
Research methods. The study included 120 pregnant women with PROM: Group 1 with vaginal birth (VB) included 95 women (79.2%), of whom 65 (68.4%) had spontaneous labor that ended in delivery and 30 (31.6%) after labor induction with oxytocin. Group 2 included 14 (11.6%) with abdominal delivery in the absence of spontaneous labor induction (AD), of whom 7 (5.8%) underwent cesarean section immediately according to indications and 7 (5.8%) in the absence of labor despite labor induction with oxytocin. Group 3 included 11 (9.2%) patients with emergency cesarean section in the presence of spontaneous labor (ECS). Descriptive statistics are presented as mean and standard deviation or median and interquartile range. For normally distributed data, the Shapiro-Wilk test was used. Differences were considered statistically significant at p ≤ 0.05. Calculations and graphical plots were performed using the R statistical environment (v. 3.6, GNU GPL2 license).
Results. In 84% of cases, expectant management for 4-27 hours resulted in vaginal delivery with favorable outcomes for both mother and fetus. Low parity combined with meconium-stained amniotic fluid is associated with an increased risk of primary labor insufficiency and operative delivery.
Conclusion. Expectant management in women with PROM is justified if the fetus is tolerant to labor, the size of the fetus and the mother's pelvis corresponds, and there are no signs of an infectious or inflammatory process.
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1. Morozova MA, Bezhenar` VF. Premature rupture of membranes: the state of the problem and approaches to rational tactics of labor management. Journal of obstetrics and women's diseases. 2023; 72(3): 77-84. Russian. (Морозова М.А., Беженарь В.Ф. Преждевременное излитие околоплодных вод: состояние проблемы и подходы к рациональной тактике ведения родов //Журнал акушерства и женских болезней. 2023. Т. 72, № 3. С. 77-84.) doi: 10.17816/JOWD202804
2. Yakovenko E.P., Zaxarenkova T.N. Premature rupture of membranes in full-term pregnancy: current data on risk factors, pathogenesis, and labor management tactics. Journal Meditsinskie novosti. 2025; 6(369): 25-30. Belarus (Яковенко Е.П., Захаренкова Т.Н. Преждевременный разрыв плодных оболочек при доношенной беременности: современные данные о факторах риска, патогенезе, тактике ведения родов //Медицинские новости. 2025. № 6(369). С. 25-30.)
3. Baisova AR, Amiraslanov E`Yu, Frankevich VE, Chagovecz VV, Tyutyunnik VL. Modern concepts on the etiology and pathogenesis of premature rupture of membranes. Obstetrics and Gynecology. 2023; 10: 21-27. Russian (Баисова А.Р., Амирасланов Э.Ю., Франкевич В.Е., Чаговец В.В., Тютюнник В.Л. Современные представления об этиологии и патогенезе преждевременного разрыва плодных оболочек //Акушерство и гинекология. 2023. № 10. С. 21-27.) doi: 10.18565/aig.2023.199
4. Šket T, Ramuta TŽ, Starčič Erjavec M, Kreft ME. The role of innate immune system in the human amniotic membrane and human amniotic fluid in protection against intra-amniotic infections and inflammation. Front Immunol. 2021; 12: 735324. doi: 10.3389/fimmu.2021.735324
5. Кim HJ, Park KH, Joo E, Lee JY, Im EM, Lee KN, Shin S. Expression of inflammatory, angiogenic, and extracellular matrix-related mediators in the cervicovaginal fluid of women with preterm premature rupture of membranes: Relationship with acute histological chorioamnionitis. Am J Reprod Immunol. 2023; 89(5): e13697. doi: 10.1111/aji.13697
6. Karaganova EYa, Karabinovich YaV. Management of full-term labour in premature rupture of membranes. Gynecology, Obstetrics and Perinatology. 2015; 14(1): 24-30. Russian (Караганова Е. Я, Карабинович Я. В. Ведение своевременных родов при преждевременном излитии околоплодных вод //Вопросы гинекологии, акушерства и перинатологии. 2015. Т. 14, № 1. С. 24-30.)
7. Astafyev VV, Nazarova SV, Li AD, Podzolkova NM. Modern condition of the problem of the premature rupture of membranes during full-term pregnancy (review of literature). V.F. Snegirev Archives of Obstetrics and Gynecology, Russian journal. 2017; 4(4): 187-193. Russian (Астафьев В.В., Назарова С.В., Ли А.Д., Подзолкова Н.М. Современное состояние проблемы преждевременного излития околоплодных вод при доношенной беременности //Архив акушерства и гинекологии им В.Ф, Снегирева. 2017. Т. 4, № 4. С. 183-187.) doi: 10.18821/2313-8726-2017-4-4-187-193
8. Bolotskikh VM. Modern methods of management of pregnancy and childbirth complications preterm rupture of membranes at term pregnancy. Journal of obstetrics and women's diseases. 2011; 60(2): 30-39. Russian (Болотских В.М. Современные методы ведения беременности и родов, осложненных преждевременным излитие околоплодных вод при доношенном сроке //Журнал акушерства и женских болезней. 2011. Т. 60, № 2. С. 30-39.)
9. Middleton P, Shepherd E, Morris J, Crowther A, Gomersall J. Cochrane Database Syst Rev. 2020; 7(7): CD004945. doi: 10.1002/14651858.CD004945.pub5
10. Karpova AL, Mostovoj AV, Ponimanskaya MA, Li ON, Desyatnik KA, Martirosyan SV, et al. Predictors of unfavorable perinatal outcomes in premature rupture of membranes. Obstetrics, Gynecology and Reproduction. 2025; 19(4): 488-505. Russian (Карпова А.Л., Мостовой А.В., Пониманская М.А., Ли О.Н., Десятник К.А., Мартиросян С.В., и др. Предикторы неблагоприятных перинатальных исходов при преждевременном разрыве плодных оболочек //Акушерство, гинекология и репродукция. 2025. Т. 19, № 4. С. 488-505.) doi: 10.17749/2313-7347/ob.gyn.rep.2025.622
11. Pintucci A, Meregalli V, Colombo P, Fiorilli A. Premature rupture of membranes at term in low risk women: how long should we wait in the «latent phase»? J Perinat Med. 2014; 42(2): 189-196. doi: 10.1515/jpm-2013-0017
12. Melamed N, Berghella V, Ananth CV, Lipworth H, Yoon EW, Barrett J. Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM study. Am J Obstet Gynecol. 2023; 228(3): 326.e1-326.e13. doi: 10.1016/j.ajog.2022.09.018
13. Oboskalova ТА, Maksimyak OV. Premature rupture of membranes in full-term pregnancy. Russian Bulletin of Obstetrician-Gynecologist. 2021; 21(1): 54-60). (Обоскалова Т.А., Максимяк О.В. Преждевременный разрыв плодных оболочек в доношенном сроке беременности //Российский вестник акушера-гинеколога. 2021. Т. 21, № 1. С. 54-60.) doi: 10.17116/rosakush20212101154
14. Padayachee L, Kale M, Mannerfeldt J, Metcalfe A. Oral Misoprostol for Induction of Labour in Term PROM: A Systematic Review. J Obstet Gynaecol Can. 2020; 42(12): 1525-1531.e1. doi: 10.1016/j.jogc.2020.02.111