Preterm premature rupture of membranes (PPROM) is a critical obstetric complication that occurs in approximately 2–3% of pregnancies and accounts for nearly 40% of preterm births. It is associated with increased risks of neonatal morbidity, maternal infections, and adverse pregnancy outcomes. Early and accurate diagnosis of PPROM is essential for timely clinical intervention and improved perinatal outcomes.

The aim of this study is to evaluate the role of general clinical and specialized medical examinations in the diagnosis and management of PPROM. The study objectives include:

- Assessing the diagnostic value of biochemical and microbiological markers in PPROM detection.

- Evaluating the role of ultrasound and instrumental methods in pregnancy prognosis.

- Analyzing the impact of biomarker-based clinical interventions on gestational prolongation and neonatal outcomes.

MATERIALS AND METHODS

This study is based on a systematic review of clinical trials, retrospective cohort studies, and case-control analyses focused on PPROM diagnosis and management. Data were collected from leading medical databases such as PubMed, Scopus, and Google Scholar, with a focus on studies published in the last decade.

Study Population:

The analyzed studies included pregnant women diagnosed with PPROM between 24 and 36 weeks of gestation. Selection criteria comprised:

- Confirmed PPROM diagnosis via clinical and laboratory tests.

- Availability of biochemical marker data (fFN, PAMG-1, IGFBP-1, CRP, IL-6, IL-8).

- Documented pregnancy outcomes, including latency period, neonatal morbidity, and maternal complications.

Diagnostic Methods Assessed:

- Biochemical Markers: fFN, PAMG-1, IGFBP-1, and inflammatory markers for detecting amniotic fluid leakage and intra-amniotic infections.

- Microbiological Examinations: Vaginal and cervical cultures to identify infection risks.

- Ultrasound and Cervical Length Assessment: To evaluate pregnancy prognosis and preterm birth risk.

RESULTS AND DISCUSSION

Key Findings:

- Biochemical Markers: fFN showed high sensitivity (60–80%) and specificity (70–90%) in predicting preterm labor. PAMG-1 demonstrated >95% specificity in confirming membrane rupture, while IGFBP-1 was a reliable indicator of amniotic fluid leakage.

- Inflammatory Markers: CRP levels exceeding 10 mg/L correlated with intra-amniotic infection risks, necessitating early antibiotic intervention.

- Ultrasound Evaluation: Shortened cervical length (<25 mm) was strongly associated with an increased risk of preterm birth following PPROM.

- Microbiological Studies: Subclinical infections were present in 40–50% of PPROM cases, justifying routine microbiological screening.

Clinical Implications:

- Combining biochemical markers with ultrasound examination enhances the accuracy of PPROM diagnosis and pregnancy outcome predictions.

- Biomarker-driven interventions, including corticosteroids, antibiotics, and tocolytics, significantly improve neonatal survival by prolonging gestation by an average of 5–7 days.

- Implementing a multidisciplinary approach optimizes patient management and reduces maternal and neonatal complications.

CONCLUSION

General clinical and specialized medical examinations play a crucial role in the early detection, risk assessment, and management of PPROM. The integration of biochemical markers, microbiological analysis, and ultrasound assessments enhances diagnostic accuracy and informs timely medical interventions. Further research is required to refine diagnostic strategies and improve accessibility to biomarker-based testing in diverse healthcare settings.