A G2P0 at 24 weeks reports membranes may have ruptured about half an hour ago, but she is unsure. She has active fetal movement and no contractions. What is the most likely diagnosis?

• A. Term PROM.
• B. Amniotic fluid leakage due to vaginal infection.
• C. Preterm PROM.
• D. False labor.

Answer: (C)

Rupture of membranes before labor in a pregnancy still well before term is the situation here. At 24 weeks, any rupture of membranes prior to onset of labor is classified as preterm PROM. The fact that she has movement of the fetus and no contractions doesn’t change this; contractions would suggest labor, not the rupture event. Term PROM would mean rupture after 37 weeks, which isn’t the case. While infection can cause vaginal discharge, it isn’t the best fit for acute membrane rupture at this gestation. If PPROM is suspected, the next steps involve confirming leakage with a sterile exam and tests, then managing to protect both mother and baby with appropriate antibiotics and fetal-maturity therapies as indicated.