Description of PROM
Premature rupture of the membranes occurs when the bag of water breaks before laboru starts. The bag of water is like a water balloon that surrounds the baby. The membranes are like the rubber of the balloon.
PROM occurs in 1 out of ten pregnancies after 37 weeks. Preterm premature rupture of the membranes is before 37 weeks (PPROM). This can lead to premature delivery. Uncontrolled leaking of fluid from the vagina is the main sign. The amount may be a lot, soaking clothing and bedding, or a little.
Sometimes additional tests may be required to tell if the membranes are ruptured. A speculum exam of the vaginal canal to look for a pool of typical fluid is often recommended.
Loss of urine with coughing or sneezing, vaginal infections, and normal vaginal secretions may be confused with PROM. Women should report any unusual fluid leakage to their providers.
Impact on Pregnancy
Preterm PROM (PPROM) occurs before 37 weeks. It is a common cause of premature delivery.
About 11% of babies in the USA are born prematurely. A fourth to a third of these are due to PPROM.
Delivery will occur within one week in three out of four cases.
The earlier in pregnancy that PPROM occurs, the longer the time before delivery. In some cases, the delivery may not occur for 3-4 weeks. This is good because it gives the fetus more time to grow and develop. Unfortunately, the risk of early delivery is still very great. So, the earlier in the pregnancy that PROM occurs the greater the potential for problems.
- Factors that increase the risk of preterm PROM
- Infection:
- genital tract infections including sexually transmitted infections
- Previous preterm PROM
- Cervical surgery including cone biopsies, or a cerclage suture to hold it closed.
- Cigarette smoking.
- PPROM may result in:
- Preterm delivery- This is the most common problem.
- Infection- This can show up as a fever and tender uterus or there may be no obvious symptoms.
- Caesarean section:
- If the fetus is not coming head first
- If the fetus does not tolerate labour.
If PPROM is not recognized and properly managed, stillbirth can infrequently occur. Even in patients with properly managed PPROM, there is a small increased risk of stillbirth.
Special Prenatal / Birth / Neonatal considerations
Women are usually hospitalized so as to observe them carefully for evidence of infection, umbilical cord compression and premature o check of the cervix will usually be avoided to reduce the risk of infection. Antibiotics will be recommended in selected situations to reduce the infection risk and possibly to prolong the pregnancy.
If the home hospital does not have a nursery that can care for preterm babies, most women are transferred to a hospital with a neonatal intensive care unit. Steroids are often used to help the fetus’ lungs develop quicker.
