Choose a topic to read

• Polycystic ovary syndrome
• Signs and symptoms of polycystic Ovary Syndrome
• Causes of polycystic ovary syndrome
• Diagnosis of polycystic ovary syndrome
• Treatment of polycystic ovary syndrome
• Preventing polycystic ovary syndrome
• Frequently asked questions
• A note from MedPark

Premature Rupture of Membranes 

Premature rupture of membranes (PROM) refers to the leakage of amniotic fluid before the onset of labor. If the membranes rupture after 37 weeks of gestation, doctors typically recommend immediate delivery. However, if the rupture occurs before 37 weeks, the medical team must carefully weigh the risks associated with preterm birth against the potential complications of prolonging the pregnancy, such as infection. The decision will be based on a thorough assessment of risks and medical appropriateness, ensuring the safety of both the mother and the baby. 

What is premature rupture of membranes (PROM)? 

Premature rupture of membranes (PROM) occurs when the amniotic sac ruptures before the onset of labor. The amniotic sac protects the fetus from infection, cushions its movements, and supports the development of muscles and bones. When the membranes break, amniotic fluid gradually leaks or gushes out of the vagina. This condition poses risks such as infection, preterm birth, and other complications. 

What is preterm premature rupture of membranes (PPROM)? 

The rupture of membranes before 37 weeks of pregnancy is termed preterm premature rupture of membranes (PPROM). In such cases, your doctor will decide whether immediate delivery is necessary or can be delayed safely. While continuing the pregnancy after the membranes have ruptured increases the risk of infection and other complications, premature birth also entails significant risks. Your doctor will meticulously weigh these risks to make the best possible decision for your and the fetal health. 

How common is PROM? 

Around 10% of pregnant women can experience PROM. Approximately 95% of PROM leads to unavoidable childbirth. PPROM affects approximately 3% of pregnancies and is more common in twin pregnancies.

What are the complications of PROM? 

If the water breaks prematurely, both the mother and the baby are at an increased risk of infection, particularly in the uterine cavity. For pregnancies less than 37 weeks, this can lead to preterm birth with immature lungs. The baby may experience respiratory distress syndrome (RDS) due to underdeveloped lungs and face difficulties in maintaining body temperature. Additionally, the fetal position at the time may not be favorable for delivery, potentially complicating the birthing process. 

What causes Premature Rupture of Membranes? 

The primary cause of premature rupture of membranes (PROM) is the weakening of the amniotic sac due to uterine contractions, which may occur without you noticing or being aware of them. 

Preterm premature rupture of membranes (PPROM), which occurs before 37 weeks of gestation, is often attributed to underlying medical conditions or complications during pregnancy, such as vaginal bleeding or congenital disorders affecting connective tissue strength, like Ehlers-Danlos Syndrome (EDS). However, in some cases, the exact cause remains unidentified. 

What are the symptoms of PROM? 

You will feel a trickle or gush of uncontrollable fluid from your vagina. It can be hard to differentiate the amniotic fluid from urine and vaginal discharge. One helpful method is to place a white paper towel on the fluid. Seek immediate medical attention if the fluid is clear and odorless.  

What increases the risk of PROM? 

The risk of PROM heightens if you have conditions that cause the weakening of the chorioamnionitis membrane, including: 

• Amniocentesis 
• History of PROM or preterm labor  
• Infections such as sexually transmitted infections (STIs) or bacterial vaginosis 
• Multiple pregnancies 
• Polyhydramnios 
• Short cervical length 
• Vaginal bleeding 

What are the diagnostic methods for PROM? 

• Sterile speculum exam: During this procedure, your doctor inserts a speculum into your vagina to collect a sample of fluid for testing. In some cases, visual confirmation of the rupture of membranes is possible if there is pooling of amniotic fluid at the cervix during the exam.
• Ultrasound can assess the fetal position and measure the quantity of amniotic fluid in the uterus.
• Nitrazine paper: A drop of vaginal fluid placed on a strip of atrazine paper can gauge the pH of the fluids. If the paper turns blue, it means the fluid on the paper has a pH of greater than 6.0 and is likely amniotic fluid.
• Fern test: Your fluid sample will be examined under a microscope to see whether it has the fern-like pattern characteristic of dry amniotic fluid. 

What are the complications of PROM? 

• Premature birth (The baby is born before 37 weeks of pregnancy.) often entails respiratory issues, decreased body temperature, and poor growth. Some premature infants also have developmental delays later in life. 
• Infections, such as chorioamnionitis 
• Placental abruption. 
• Umbilical cord compression or umbilical cord prolapse 

Your doctor will evaluate the risks and benefits of preterm delivery compared to the potential for infection and other complications of prolonging the pregnancy. This assessment helps determine the most appropriate time for delivery. 

What are treatment modalities for PROM? 

Treatment options vary based on the gestational age of the pregnancy, the fetal health, and the severity of the condition. Typically, there are two main approaches: delivery and expectant management. Expectant management involves treatments aimed at delaying labor and may include measures such as bed rest, medications, and regular monitoring for signs of infection or fetal distress. 

Treatment for PROM after 37 weeks
If the water breaks between 37 and 40 weeks of pregnancy, childbirth often occurs within 24 hours, which is the safest timeframe. The doctor may induce labor with medication, or you may naturally go into labor. 

Treatment for PROM between 34 to 37 weeks
Your pregnancy doctor will carefully consider the risks of premature birth alongside other risks if allowing the pregnancy to continue. If delivery is deemed necessary, specialized care in a neonatal intensive care unit (NICU) is vital to ensure optimal treatment for the baby after birth. 

Treatment for preterm PROM (less than 34 weeks pregnant)
Complications associated with prematurity are particularly significant when the fetus is less than 34 weeks gestation. In such cases, you are likely to be admitted to the hospital for bed rest to prolong the pregnancy. In addition, various treatments will be administered, including corticosteroids to speed up fetal lung development, antibiotics to prevent infection and extend the pregnancy, tocolytics to halt labor, and magnesium sulfate to support fetal brain development. Doctors will closely monitor for infections and fetal distress by assessing the fetal heart rate and movement. These interventions are to prolong the pregnancy to at least 34 weeks. If an infection is evident after the membrane ruptures, delivery becomes imperative. 

Can the Premature Rupture of Membranes be prevented?

While PROM is not entirely preventable, attending regular prenatal clinic visits, prioritizing a healthy pregnancy, and abstaining from smoking can minimize the risk. 

Frequently Asked Questions (FAQ)

• How soon should I deliver after PROM?
  Delivering the baby within 24 hours after the rupture of membranes helps reduce the risk of infection. However, the doctor will prioritize the safety of both the mother and the baby when making decisions.
• How long can I prolong the pregnancy after a ruptured membrane?
  The decision varies depending on the circumstances and gestational age. If the rupture of membranes occurs before 37 weeks of gestation and there is evidence of infection or complications, the doctor may deem it necessary to deliver the baby immediately.
• Can a baby survive premature rupture of membranes?
  Yes, a fetus can survive despite premature rupture of membranes, with survival rates contingent upon gestational age and the remaining amount of amniotic fluid. Physicians monitor fetal distress and infection risk to determine the appropriate timing for delivery. 

A note from MedPark’s doctors

Throughout pregnancy, the amniotic sac serves to envelop and protect the fetus. Should the amniotic sac rupture after 37 weeks, your doctor will recommend delivery. However, if the rupture occurs before 37 weeks, your doctor will weigh the risks of preterm delivery against other potential complications. Nevertheless, in the event of a ruptured membrane, it is advisable to seek medical evaluation and detailed examination promptly.