ABSTRACT A REVIEW OF THE ETIOLOGY EPIDEMIOLOGY PREDICTION AND INTERVENTIONS OF PRETERM PREMATURE RUPTURE OF MEMBRANES. ByMadhavi Kishor ThombrePreterm premature rupture of membranes (PPROM) is a clinical subtype of preterm delivery (PTD) with multi factorial etiology and itself a determinant of preterm delivery. Challenges in study of PPROM include variable case definition, outcome misclassification due to inaccurate identification of the initiating event, heterogeneity of pathways leading to PPROM and inconsistent evidence in assessing risk factors. Neonatal outcomes following preterm premature rupture of membranes vary depending on gestational age and latency. Preterm premature rupture of membranes has been described as a complex auto toxic condition and its pathogenesis involves the activation and interaction of the cytokines, matrix metalloproteinases and the apoptosis pathways. Genetic variation and behavioral and environmental risk factors can add complexities to understanding these pathways. PPROM is the strongest predictor of preterm delivery but PPROM prediction has been a challenging issue. A combination of factors, short cervix, previous preterm delivery due to PPROM, and presence of fetal fibronectin seem to be the strongest predictors of PPROM at less than 37 and less than 35 weeks gestation. Intra amniotic infection as indicated by elevated cytokine levels in vaginal fluids also seems to predict PPROM with good sensitivity and modest specificity. Interventional studies to prevent PPROM in have largely been unsuccessful; specifically antibiotic trials in women with bacterial vaginosis have not yielded satisfactory results.
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