Summary : Premature rupture of membranes (PROM) is defined as rupture of the membranes before the onset of labor at term, while preterm rupture of the membranes is rupture before the fetal maturity (37 or 38 weeks). It is apparent till now that there is no single cause of PROM For all practical purposes, the cause of PROM is a reduction in membrane strength by the effect of bacterial proteases and other factors that may facilitate ascending infection such as cervical incompetence.and repeated pelvic examination. The role of inflammatory mediators (interleukins) is very important. A number of pregnancy related conditions have been implicated in the etiology of PROM, also sexual activity can theoretically initiate preterm labor and PROM as well as smoking. The diagnosis of PROM can be easily made if the pregnant women give a history of watery vaginal discharge of sudden onset or small intermittent vaginal leak. Clinical examination using single sterile speculum examination will reveal amniotic fluid in the vaginal vault and can be helped by gentle fundal pressure. Although several diagnostic tests for the detection of ruptured membrane have been recommended, none is completely reliable. Laboratory tests include Nitrazine test, Fern test, and the evaporation test can be used. Modem trends in the management of PROM aim at confirmation diagnosis of PROM, early detection of intra-amniotic infection, as will as methods to overcome the complication of prematurity. Vaginal fluid HCG levels can confirm the diagnosis. Detection of fetal fibronectin in cervicovaginal secretions prior to membrane rupture may be a marker of impending preterm labor. Alpha-fetoprotein (AFP) test has a sensitivity of 98 %and specificity of 100% in diagnosis of PROM. Insulin-like-growth factor binding protein-1 a test that is not affected by contamination, cervical dilatation or uterine contraction and stromelysin 1 increase during preterm PROM. Ultra-sound examination should not be used as primary means of diagnosis of PROM. The method most commonly used is the four-quadrant technique. Injection of flourescein into the amniotic cavity is rarely indicated for the diagnosis of PROM. PROM must be differentiated from high leak, leucorrhoea, infections and urinary incontinence. Despite recent publications identifying prematurely as the major problem for the neonate, the adverse effects of intra amniotic infection remains the most troublesome problem. Microbial invasion of the amniotic cavity occurs in approximately 30% of women with PROM. Many organisms are responsible for chorioamnionitis but particular attention must be given to GBS . In these patients PROM occur at an early gestational age and a shorter latent period. Amniotic fluid WBCs count in the diagnosis of chorio-amnionitis performs better than C-reactive protein and maternal WBCs. Maternal serum IL-6 and IL 8 and amniotic fluid IL 6, IL 8 and TNF levels are higher in PROM, and there is a significant increase in amniotic fluid IL-16 concentration in PROM. Other complications of PROM includes hyaline membrane disease, amniotic band syndrome, pulmonary hypoplasia , Abruptio placenta, fetal distress , congenital abnormalities and thromboembolic events . Management of PROM will depend, after confirmation of rupture, upon gestational age at the time of rupture. Immediate delivery is indicated in patients in labor, with mature fetal lungs, fetal malformation, fetal distress, overt infection, subclinical amnionits and patients at high risk for infection. Patients with PROM after 34 weeks should be delivered by induction of labor by IV oxytocin if there is no indication for cesarean delivery. The incidence of clinical amniontis and endometritis doesn't increase with induction of labor was by endocervical PGE2. Patients with PROM before 34 weeks should be managed expectantly using antibiotics, corticosteroid after hospitalization. Patients before 24 weeks are managed with amnioinfusion and fibrin sealants in association with expectant management.