Successful Management of Preterm Premature Rupture of Membrane in Second Trimester: A Case Report and Literature Review

Abstract

The preterm premature rupture of membranes occurring in early pregnancy at less than 23-24 weeks (prior to fetal viability), has higher risk for early preterm delivery, and therefore, the poorer the prognosis with poor chance of neonatal survival and a high rate of severe, long-term neonatal morbidity among survivors. In such cases in absence of overt evidence of intrauterine infection at the time of diagnosis termination of pregnancy or expectant management is generally offered modality of treatment, the prior being commonly preffered. When expectant management is instituted, it is very rare that spontaneous resealing of the membranes occurs with the outcome that is equivocal to normal pregnancy. The presented case is an example of this rare happening. A 25-year-old, mangolian, primigravida at 20 weeks of pregnancy had spontaneous preterm premature rupture of membranes. After 8 days of expectant management, she had cessation of amniotic fluid leak and could continue pregnancy till term with normal feto-maternal outcome at 37 weeks of pregnancy. The risk of infection increases with prolongation of latency period but in this case, the latency period was prolonged for more than 16 weeks and there was no evidence of infection, with normal feto-maternal outcome at term. This is the first case of its kind happened in our hospital and deserves to be reported. It is expected that this article will reveal the possibility of resealing of spontaneous preterm premature rupture of membrane with proper expectant management.

Comparison between static and dynamic cervical assessment in prediction of preterm birth

“…These findings showed that the earlier in gestation the rupture occurs, the less likely labor will begin inside the time periods specified. 14,30 El Sokkary et al study noted a positive correlation among cervical length and latency interval. Mehra et al reported that shorter transvaginal cervical length independently predicts delivery within 7 days in women with PPROM.…”

“…13,22,26 Researchers found that a dynamically changing cervix increases the accuracy of cervical length in predicting preterm birth, either spontaneously or in response to fundal pressure. 14,15 The many dynamic cervical assessment techniques include the Valsalva maneuver, cervical length ultrasonography, contraction monitoring during a 10minute period, and watching the change in the cervical appearance in response to fundal pressure for 15 seconds. During a 5-minute TVUS cervical scan, there may be spontaneous funnelling.…”