Moreover, since the AF concentration of several biomarkers is higher than that in normal vaginal secretion, many studies investigated the diagnostic value of vaginal AF for an early and accurate diagnosis of PROM. Albeit these techniques have been employed for more than 60 years, the nitrazine test has been recently discouraged. Strategies currently performed consist of sterile speculum examination and nitrazine or fern tests, while ultrasound is useful to identify an AF reduction in the case of suspect membrane rupture. Notably, there is no universally accepted method for the diagnosis of PROM. Although the exact aetiology is unclear, known factors are collagen remodelling, apoptosis, increased transcription of matrix metalloproteinases (MMP) such as MMP9, AF apoptotic activators, and polymorphism promoter of tumour necrosis factor α (TNF-α), interleukin-1 (IL-1), and MMP1. Indeed, growing evidences on this phenomenon suggest possible short- and long-term risks on maternal and foetal microbiota, resulting in long-term sequelae such as obesity, food allergies and intolerances, autoimmune diseases, and possible neurodevelopmental involvement. Moreover, given the increasing antibiotic resistance, alerts have been issued about the use and abuse of prophylactic antibiotic administration. These practices may in turn affect several women in the positive experience of birth. Therefore, from PROM, diagnosis may derive different medical procedures such as hospitalization, antibiotic prophylaxis, and induction of labour through oxytocin, that is, increased medicalization and caesarean section rates. Foetal complications of PROM include neonatal sepsis, abnormal foetal presentation, cord prolapse or compression, and abruptio placentae, and these may increase the risk of neonatal intraventricular haemorrhage, leading to neurodevelopmental disability as a direct consequence. The most commonly diagnosed maternal infections in case of PROM are chorioamnionitis and endometritis, which may be further promoted by frequent vaginal exams and the presence of meconium in the amniotic fluid (AF). Foetal membranes are of pivotal importance because they offer a robust barrier against infection ascending from the reproductive tract after their rupture, both the mother and foetus are at risk of infection and other complications. It can be observed at any gestational age and occurs in approximately 10% of pregnant women and in roughly 40% of preterm deliveries. Among these, premature rupture of membranes (PROM) consists of the rupture of the foetal membranes before the onset of labour.
The early diagnosis of pregnancy-related complications and the prediction of pregnancy outcome are considered strategic clinical goals to ensure the health of mothers and of their babies.
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