How do you get Premature Rupture of Membranes?

Premature Rupture of Membranes (PROM) can occur due to various reasons, including the weakening of the membrane over time, pressure from uterine contractions, and the presence of an infection inside the sac holding the baby. Other risk factors include a history of PROM, a shorter cervical length, bleeding in the second or third trimester, excessive stretching of the uterus, nutritional deficiencies, connective tissue disorders, lower body weight, socioeconomic disadvantage, smoking, and drug use. However, the exact reason for early water breaking may not always be pinpointed by doctors.

What else can Premature Rupture of Membranes be?

Crohn's disease, Lower urinary tract infection, Rectovaginal fistula, Urinary incontinence, Recent trauma or surgery in the urinary and genital area, Use of vaginal douches, Vaginitis, Vesicovaginal fistula.

What kinds of test are needed for Premature Rupture of Membranes?

The types of tests that a doctor would order to properly diagnose Premature Rupture of Membranes include: - Microscopic examination of amniotic fluid for fern-like patterns - pH test on vaginal fluid - Ultrasound to measure the amount of amniotic fluid - Testing for fetal fibronectin - Commercial tests for detecting proteins from the amniotic fluid - Injection of a harmless blue dye into the amniotic fluid to check if it passes through the vagina

How is Premature Rupture of Membranes treated?

The treatment for Premature Rupture of Membranes depends on the gestational age of the patient. For patients at 37 weeks or later, delivery is encouraged, and medication may be given to prevent Group B Streptococcus infection. For patients between 34 and almost 37 weeks, the approach is similar, but more watchful. Antibiotics and a single course of corticosteroids are given to prolong the period before labor and help develop the baby's lungs. For patients less than 24 weeks along, counseling is provided, and careful management or inducing labor may be considered. Antibiotics can be given as early as 20 weeks, but certain drug interventions are not recommended before the pregnancy reaches a viable stage.

What are the side effects when treating Premature Rupture of Membranes?

The possible risks and side effects when treating Premature Rupture of Membranes include: - Infection in both the baby and the mother - Risk of infant death around the time of birth - Breathing difficulties in the newborn - Bleeding within the brain of the infant - Underdeveloped lungs in the baby - Potential necessity for a Cesarean section for delivery

What type of doctor should I see for Premature Rupture of Membranes?

An obstetrician or a gynecologist.

Premature Rupture of Membranes

What is Premature Rupture of Membranes?

Prelabor rupture of membranes (PROM) is when the protective sac around a baby in the womb breaks before labor begins. If this breakage happens before labor and also before 37 weeks of pregnancy, it’s known as preterm PROM (PPROM).

What Causes Premature Rupture of Membranes?

The reasons behind the early breaking of water, or prelabor rupture of membranes, before labor starts can vary greatly. It might happen because the membrane, or the sac that holds the baby, naturally weakens overtime, and the pressure from uterine contractions, or the muscles of your uterus tightening, can cause it to rupture.

A common link is the presence of an infection inside the sac holding the baby, especially with PPROM, which is when the water breaks too early, before 37 weeks of gestation. Other risk factors for early water breakage include having a history of PPROM, a shorter cervical length (shorter neck of the womb), bleeding in your second or third trimester, excessive stretching of the uterus, not having enough copper and ascorbic acid in your diet, having connective tissue disorders, having a lower body weight than average, being economically disadvantaged, smoking cigarettes or using illegal drugs.

Despite knowing these potential causes sometimes, doctors are not able to pinpoint the exact reason why the water broke early in a patient.

Risk Factors and Frequency for Premature Rupture of Membranes

Premature Rupture of the Membranes (PROM) is a complication that can occur during pregnancy. At full term, around 8% of pregnancies experience PROM. Additionally, PROM in preterm pregnancies affects about 1% of all deliveries, and it’s twice as common in African Americans.

Signs and Symptoms of Premature Rupture of Membranes

When someone complains of fluid leakage, a detailed history should be taken into account. The things to note, include the current situation, any relevant past surgeries, pregnancies or gynecological issues, other health conditions, social factors, and family health history. During the discussion, it’s crucial to gather information about contractions, movement of the baby, potential time of the rupture, amount and character of the fluid (color and odor), any blood flows, pain, recent sexual activities, any recent shocks or injuries, and recent physical excursions.

Subsequently, a physical examination needs to be carried out carefully to prevent infections. This generally involves a sterile speculum exam. The patient is checked for signs of cervix inflammation, instances of the umbilical cord slipping out of place, any bleeding, or the baby coming down prematurely. In order to avoid infection risks, a digital exam should be refrained unless the patient seems close to delivering or is in active labor. The condition of the cervix, mainly its dilation and thinning, needs to be checked during the sterile speculum exam. If deemed necessary, samples for culture test should be taken during the examination. The presence of amniotic fluid flowing from the cervix and accumulating in the vagina usually confirms a diagnosis of the membrane rupture.

Testing for Premature Rupture of Membranes

When doctors suspect that a pregnant woman’s amniotic sac (or ‘water’) has broken, they might perform a few tests. One of these involves looking at amniotic fluid under a microscope for fern-like patterns, known as ‘ferning’ or ‘arborization’.

Doctors may also perform a pH test on vaginal fluid. Amniotic fluid, the fluid surrounding the embryo or fetus, typically has a pH level (a measure of acidity or alkalinity) of 7.1-7.3, whereas normal vaginal secretions generally have a pH of 4.5-6.0. However, this test isn’t perfect. The presence of blood, semen, alkaline antiseptics, or an infection type called bacterial vaginosis can cause a false-positive result. Conversely, if the membranes have been ruptured for a while, the test might produce a false-negative outcome.

If the diagnosis still isn’t definite, additional tests may help. An ultrasound can be performed to measure the amount of amniotic fluid. Fetal fibronectin, a protein that acts like a biological glue between the baby and the womb, can also be tested, though it’s not very specific to rupturing of membranes. There are also several commercial tests available for detecting proteins from the amniotic fluid, which can quite accurately pinpoint if the membranes have ruptured.

If doctors still can’t determine the condition, they might resort to injecting a harmless blue dye, indigo carmine, into the amniotic fluid through an ultrasound-guided procedure. Afterward, a pad or tampon is used to check if this dyed fluid has passed through the vagina. If the pad or tampon turns blue, it confirms that the membranes have indeed ruptured.

Treatment Options for Premature Rupture of Membranes

How we manage patients who experience prelabor rupture of membranes, a condition where the fluid-filled bag surrounding the baby breaks before labour starts, depends on how far along in the pregnancy the patient is. For patients who are at 37 weeks or later, they are encouraged to go ahead with delivery and, if necessary, to take medication that can help prevent Group B Streptococcus infection, a type of bacterial infection that can affect the baby.

This approach is the same for late preterm patients, who are between 34 and almost 37 weeks. For preterm patients between 24 and almost 34 weeks, the approach is more watchful. Doctors will monitor these patients, give antibiotics to prolong the period before labor sets in and a single course of corticosteroids, a type of steroid hormone, to help develop the baby’s lungs faster. Again, Group B Streptococcus prevention is given if needed.

For patients less than 24 weeks along, doctors will provide counseling and consider more careful management or inducing labor. Antibiotics can be given as early as 20 weeks along, but certain drug interventions are not recommended before the pregnancy reaches a viable stage.

If the baby isn’t doing well or if an infection of the tissue around the baby (chorioamnionitis) is present, delivery may be necessary. If the patient has vaginal bleeding, this might indicate a problem with placenta separation and delivery should be considered. Delivery decisions will be based on the baby’s condition, the amount of bleeding, the mother’s stability, and how far along in the pregnancy the woman is.

Patients with preterm rupture of membranes are usually admitted to the hospital for periodic checks for infection, complications with the placenta, issues with the umbilical cord, the baby’s well-being, and signs of labor. Regular ultrasounds are performed to monitor the baby’s growth and heart rate. A rise in the mother’s temperature might suggest an infection inside the uterus. Certain signs of inflammation or infection aren’t very specific or helpful unless there’s already clinical evidence of infection. Drug therapy can also temporarily raise some signs of inflammation or infection.

The use of drugs to delay labor (tocolytics) in preterm rupture of membranes patients is a subject of debate. While they might delay labor and lower the risk of delivery within 48 hours, such medications are also linked with a higher risk of tissue infection around the baby in pregnancies before 34 weeks. Their use hasn’t shown significant benefits for the mother or baby.

Using antenatal corticosteroids after preterm rupture of membranes can cut down on the chances of the baby dying, developing respiratory distress syndrome, or suffering from severe inflammation of the gut and bleeding inside the brain. A single course of corticosteroids is recommended for all pregnant women between 24 weeks and 34 weeks of gestation if there is a risk of delivery in the next 7 days.

Administering magnesium sulfate should be considered when delivery is anticipated before 32 weeks of gestation in order to decrease the chance of cerebral palsy, a disorder affecting movement, muscle tone, or posture.

Antibiotics have shown to make the pregnancy last longer, decrease infections in mother and baby, and cut down on baby illness. A seven-day course of therapy is generally suggested for women with preterm rupture of membranes who are under 34 weeks of gestation. A specific combination of antibiotics is normally recommended for this.

Women who have had a history of preterm rupture of membranes are more likely to experience this condition and premature birth in the future. The supplementation of progesterone, a type of hormone, can help lower the chance of premature birth occurring naturally.

The following are some possible medical conditions or situations that might be considered: