Prolonged rupture of membranes and pulmonary hypoplasia in very preterm infants: pathophysiology and guided treatment

Preterm premature rupture of the fetal membranes (PPROM) with loss of amniotic fluid in the second trimester is associated with high perinatal mortality and can cause major neonatal morbidity. Premature rupture of membranes complicates up to 3% of all pregnancies, with 0.4% of ruptures occurring before or near the limit of viability.1 Approximately one-half of the pregnancies will deliver within 1 week after the membranes rupture and up to 70% within 5 weeks. Besides extreme prematurity and sepsis, hypoxic respiratory failure attributable to presumed pulmonary hypoplasia is a major contributor to the quoted high mortality of infants born after PPROM