New horizons in the treatment of preterm premature rupture of membranes

In the last 5 years, significant experience has been gained in the clinical understanding and treatment of PPROM. From this work, one can conclude that iatrogenic PPROM is not only a different entity etiologically, but also in its clinical behavior and response to therapeutic measures. The current success rate with the amniopatch allows the author to suggest that iatrogenic PPROM should no longer be viewed as a devastating complication of pregnancy. Instead, it should be viewed as a readily treatable condition with the amniopatch. Regarding spontaneous PPROM, work suggests that perhaps, in a select group of patients in which infection has not set in and in which a smaller and better defined membrane defect may exist, there is the potential for developing a surgical technique that may successfully graft the defect and allow the integrity of the amniotic membrane to be restored. The actual surgical technique, the materials to be used, and the approach (transabdominal versus transcervical) are all areas of research for the future. Meanwhile, continued efforts are warranted to decipher whether this obstetric complication can one day be conquered.