Premature Rupture Of Membranes
The membranes that hold amniotic fluid (the water surrounding the baby) usually break at the end of the first stage of labor. However, in about 10% of pregnancies after 37 weeks, the membranes will break before labor. This is referred to as premature rupture of membranes (PROM). That’s difference from preterm premature rupture of membranes (PPROM), which is when the membranes rupture before 37 weeks.
Why Does It Happen?
In the majority of cases of PROM the cause is unknown. Some causes are thought to be:
- Uterine or genital tract infections, including sexually transmitted diseases
- Poor nutrition
- Overstretching of the uterus and amniotic sac, which sometimes occurs with multiple fetuses or too much amniotic fluid (hydramnios)
- Cigarette smoking
- Increased susceptibility if it occurred in previous pregnancies
- Previous cervical surgery, including cone biopsies or cerclage suture to hold the cervix closed
Most women whose membranes rupture before labor don’t have a risk factor.
How Do I Know I Have It?
The most important symptom of PROM is fluid leaking from the vagina. It may leak slowly or may gush out. Sometimes when it leaks out slowly, women mistake it for urine. Although some of the fluid is lost when the membranes rupture, the baby continues to produce more, so it may continue to leak.
If you suspect PROM, it is very important to contact your health care provider immediately to obtain appropriate medical care for you and your baby. Tests to confirm the diagnosis of PROM include medical history, physical exam, lab tests, and sterile speculum vaginal exam for the presence of a pool of amniotic fluid in the vagina.
What Will Happen?
If your health care provider confirms that your membranes have ruptured, you will probably be admitted to the hospital until your baby is born. If your pregnancy is past 37 weeks, your baby is ready to be born, and it’s only a matter of when you will go into labor. You can either wait until you go into labor on your own, or start medication to encourage contractions to start earlier. Studies suggest that women who have labor induced are less likely to develop an infection in their uterus than those who wait for labor to start naturally. Many health care providers will recommend labor-inducing medications if you don’t go into labor on your own after a few hours.
If you are between 34 and 37 weeks when your water breaks, health care providers will often go ahead and induce labor. It’s thought that your risk of infection is greater than the risk of your baby being born a few weeks early.
If it is before 34 weeks, the situation becomes more complex. If there are no signs of infection, the doctor may try to delay labor with medication until the baby's lungs are more mature. Antibiotics are usually given. Steroids are often given to help the baby's lungs develop quicker. You and your baby will be hospitalized and monitored carefully. Your doctor may also collect a sample of fluid and analyze it to see if your baby’s lungs are mature. If they are, labor will be induced.
The key to understanding PPROM (preterm premature rupture of membranes) is this: The only thing more worrisome than a premature baby is a premature baby with an infection. Ideally, your doctors want you to deliver the hour before your uterus and your baby get infected, and that’s impossible to predict. Without a crystal ball, they will rely on subtle signs of infection or changes in your baby’s testing to decide when it’s time for her to be born.
Approximately 11% of babies in the US are born prematurely and 3-4% of those are due to PPROM. The earlier in the pregnancy that PPROM takes place, the greater the risk for potential problems. If the hospital you are admitted to does not have a preterm nursery, you will likely be transferred to a hospital with a neonatal intensive care unit. While infrequent, even with proper medical care there is a small increased risk of stillbirth with preterm PPROM.
Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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