ABSTRACT
DEFINITION PPROM refers to chorioamniotic membrane rupture before the onset of labor in pregnancies at <37 weeks of gestation.
DIAGNOSIS Definite diagnosis is by direct visualization of fluid (pooling) in the posterior vaginal fornix at sterile speculum examination. Confirmatory tests commonly done are nitrazine test on a cervicovaginal swab and the presence of arborization (ferning). History of persistent leakage of fluid and ultrasonographic diagnosis of oligohydramnios are two other confirmatory but not diagnostic findings. A negative fetal fibronectin assay after 21 weeks of gestation has a negative predictive value of only 81% to 99% and is not recommended. Although promising at preliminary studies, there is insufficient evidence to assess if the use of placental alpha-microglobulin-1 rapid immunoassay (AmniSure) and of an absorbent pad that changes color at pH > 5.2 (AmnioSense) significantly improve the accuracy provided by previous tests (1).
