Preterm Premature Rupture of Membranes

Premature rupture of membrane (PROM) is a common complication of pregnancy, affecting between 8-10% of all births.1 Typically, the risks associated with PROM can be easily managed by inducing labor or taking other precautions. However, when PROM occurs before 37 weeks’ gestation, it poses a serious risk to fetal health. This condition, known as preterm premature rupture of membranes (pPROM), affects approximately 3% of births in the US.2

pPROM Risks and Complications

Complications of pPROM include respiratory distress syndrome, umbilical cord prolapse and placental abruption. pPROM is implicated in one third of preterm births2 and between 18-20% of perinatal deaths.1 Studies have demonstrated a statistical correlation between the gestational age at which PROM occurs and the length of the latency period.3 The closer to term the ROM occurs, the shorter the latency period. This increases both the risks associated with pPROM and the need for accurate early detection.

Preterm premature rupture of membranes (pPROM) is any rupture of the fetal membrane before 37 weeks. pPROM occurs in 3% of pregnancies. It is a major contributor to mortality, having been associated with 18-20% of all perinatal deaths in the US.2

Preterm Rupture of Membranes Symptoms


In many cases, preterm premature rupture of membrane may be identified by a visible pooling of the amniotic fluid in the posterior fornix. However, this criteria is subjective and as many as 47% of cases present no observable symptoms.4 Since the 1940s, a number of testing methods for prelabor rupture of membranes have emerged. These include pH testing with nitrazine, ferning and ultrasound — all of which suffer from poor sensitivity, specificity and overall accuracy.

The current gold standard pPROM test is by amino dye infusion. However, costs for this procedure are prohibitive and many facilities lack the resources to perform amniocentesis on every patient in need.

pPROM Testing Using PAMG-1

In recent years, biomarker testing with the protein PAMG-1 has emerged as a leading way to diagnose for preterm premature rupture of membranes. AmniSure® uses PAMG-1 to detect concentrations of the protein in cervico-vaginal discharge are negligible compared to levels in amniotic fluid.

Samples are also easy to obtain without a speculum, meaning the test can be performed at home by a nurse or qualified midwife, potentially 2am. Easy to perform and cost effective, the AmniSure® pPROM test makes it possible to detect preterm premature membrane ruptures early and intervene more effectively.

  • Caughey, AB et al. Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes. Rev. Obstet. Gynecol. 2008;1(1):11–22.
  • Medina, T and Hill, DA. Preterm Premature Rupture of Membranes: Diagnosis and Management. Am. Fam. Physician. 2006;73(4):659-664
  • Hannah ME et al. Induction of labor compared with expectant management for prelabor rupture of the membranes at term. N. Engl. J. Med. 1996;334:1005–10.
  • 47%: Neil PRL, Wallace EM. Is AmniSure® useful in the management of women with prelabour rupture of the membranes? Australian and New Zealand Journal of Obstetrics and Gynaecology 2010.

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