Premature Rupture of Fetal Membranes: A Narrative Review Integrating Current Evidence and International Guidelines for Optimal Care

Premature rupture of fetal membranes (PROM) is a significant obstetric complication associated with preterm birth and increased maternal and neonatal morbidity and mortality, particularly in resource-limited settings. It is a multifactorial condition resulting from complex interactions between infectious, inflammatory, mechanical, and biochemical processes that weaken the chorioamniotic membranes. This narrative review synthesises current evidence and international clinical guidelines on the diagnosis and management of PROM. It examines the epidemiology, risk factors, and underlying pathophysiology, with emphasis on the roles of infection, inflammatory mediators, and matrix metalloproteinases. Diagnostic strategies are reviewed, including clinical assessment, conventional bedside tests, and emerging biomarker-based approaches such as placental alpha-microglobulin-1 and insulin-like growth factor binding protein-1. Evidence-based management approaches are discussed, including prophylactic antibiotics, antenatal corticosteroids, magnesium sulphate for fetal neuroprotection, selective use of tocolysis, and gestational age-specific timing of delivery. Emerging areas, including outpatient management, prevention strategies, amnioinfusion in preterm PROM, and considerations for cerclage retention and breech presentation, are also addressed. In conclusion, this review provides a comprehensive and up-to-date synthesis of current knowledge on PROM to inform clinical practice. Improved risk stratification, timely diagnosis, and adherence to evidence-based management remain essential to optimise maternal and neonatal outcomes.