G2P1A0, 34-Week Pregnant Woman With Antepartum Status, One Previous Cesarean Section, and Preterm Premature Rupture of Membranes for 6 Hours, Fetus in Cephalic Presentation

Abstract

Preterm premature rupture of membranes (PPROM) remains a clinical challenge due to its association with increased maternal infection, neonatal complications, and the need for carefully timed delivery decisions. This case report describes a 34-week pregnant woman (G2P1A0) who presented with clear vaginal fluid leakage for six hours prior to hospital admission, without uterine contractions. Speculum examination revealed pooling of amniotic fluid with a positive nitrazine test, while ultrasonography demonstrated a live singleton fetus in cephalic presentation with adequate amniotic fluid volume. Laboratory evaluation showed a leukocyte count of 9,900/µL, which is within the physiological range for the third trimester but warrants close monitoring due to the increased risk of ascending infection in PPROM. In the absence of clinical signs of intrauterine infection, short-term expectant management was undertaken, accompanied by antibiotic therapy, tocolytics, and antenatal corticosteroids to maintain maternal–fetal stability and reduce prematurity-related risks. Considering the unripe cervix and a history of one previous cesarean section, elective cesarean delivery was chosen as the safest mode of pregnancy termination. The neonate was delivered in good condition with satisfactory APGAR scores, and the mother experienced an uneventful postoperative recovery. This case highlights that individualized, guideline-based management of PPROM at 34 weeks’ gestation can optimize maternal and neonatal outcomes.