Navigating the Grey Area: Periviable Preterm Prelabour Rupture of Membrane Complicated by Subclinical Chorioamnionitis

Abstract

Periviable preterm prelabour rupture of membranes (PPROM), defined as rupture of membranes before 26 weeks of gestation, is an uncommon but serious obstetric complication that carries significant risks of perinatal mortality and maternal morbidity. Early recognition and timely management are critical, as decisions must balance the potential for fetal survival with the risk of maternal infection and other complications. Subclinical chorioamnionitis, in particular, can develop without overt clinical signs, making diagnosis challenging and often reliant on laboratory and imaging findings.This case highlights the complex course of a 31-year-old primigravida at 25 weeks and 2 days gestation diagnosed with subclinical chorioamnionitis complicating periviable (PPROM) with severe oligohydramnios, resulting in intrauterine fetal demise despite appropriate antibiotic course initiation. This case underscores the importance of early detection of subclinical chorioamnionitis, careful surveillance, and individualized, multidisciplinary decision-making in periviable PPROM. It highlights the need for sensitive counselling to support maternal safety while considering fetal prognosis, providing a practical example of the challenges in managing high-risk periviable pregnancies.