Premature Rupture of Membranes: Causes, Risks and Treatment

Your water is suppose to break when you go into labor, as the rupturing of the amniotic sac means that it will soon be time to give birth. But what does it mean if your water breaks well before your due date? Known as premature rupture of membranes, this complication can be quite serious and requires quick attention.

Defining PROM
Premature rupture of membranes, also known as PROM, refers to when a pregnant women�s amniotic membrane, which surrounds the fetus, either bursts or suffers a hole to it. The amniotic membrane is an enclosed sac consisting of amniotic fluid, the fetus and the placenta. Amniotic fluid is important because it surrounds the fetus, protecting it from viruses and bacteria; it also allows the umbilical cord to float, providing the fetus with oxygen and nutrients. The membrane is also central to the development of the fetus�s lungs.

PROM is used in reference to a pregnant woman either at or beyond 37 weeks of gestation who experiences PROM prior to the onset of labor; preterm premature rupture of membranes (PPROM) refers to when the amniotic membrane bursts or is ruptured during the period of between 24 to 37 weeks of pregnancy. PROM occurs in 10% of pregnancies, 20% of which are cases of PPROM. Signs of PROM include a gush of blood-tinged fluid, as well as fever and foul-smelling vaginal discharge.

Why PROM Occurs
While uncertainties exist as to the exact cause of PROM, it is generally believed that it occurs due to infection during pregnancy or due to impending labor. It is believed that programmed cell death and the activation of catabolic enzymes, such as collagenase, can also result in the rupture of the membrane. Having sex during the latter stages of pregnancy is not considered a risk factor.

Who is Most at Risk of Experiencing PROM?
Pregnant women most at risk for PROM are those who smoke, have a low body mass index, have poor nutrition and hygiene, and those who have a history of preterm labor. Pregnant women with excess amniotic fluid are also at risk.

Other important factors to problems during pregnancy include whether pregnant women have had a history of infection, women who have had multiple pregnancies previous to the current pregnancy, as well as those experiencing vaginal infection during pregnancy. Babies in a breech position particularly pose a risk to complications during pregnancy.

Procedural factors also play a role in the risk of PROM; amniocentesis, as well as cerclage (when the uterus is sewn shut due to an incompetent cervix) can result in the rupture of a pregnant woman�s amniotic membrane. PROM is also identified with women who had a pelvic exam in the last three months of their pregnancy. Controllable preventions are therefore limited to abstaining from smoking during pregnancy, maintaining a healthy diet, and keeping up personal hygiene.

Risk of Miscarriage and Other Complications
PROM can lead to miscarriage, increased infection that puts both the pregnant woman and her fetus at risk, and preterm birth. Approximately 34% of premature births result because of the premature rupture of membranes during the period of between 24 to 37 weeks of pregnancy. The rupturing of the amniotic membrane during the first 24 to 26 weeks of pregnancy are particularly dangerous for the fetus, and can lead to pulmonary problems. The fetal survival at this stage of pregnancy is less than 20%.

Other risk factors in the late stages of pregnancy include the worsening of infection, including an extensive intra-amniotic infection, which leads to uterine tenderness, as well as fever and an increased heart rate in both the pregnant woman and her fetus. 90% of pregnant women enter into spontaneous labor within 24 hours of PROM when it occurs at term, making preterm birth a major danger during pregnancy.

Most cases of PROM are treated with antibiotics; the majority of studies have found that when antibiotics are prescribed, the pregnancy is prolonged, leading to a decline in the risk of both infant and maternal death. Yet a few studies have found that antibiotics increase the risk of neonatal mortality.

When PROM occurs during late pregnancy, labor is induced in order to avoid an increased risk of infection. This is particularly true when PROM occurs or when PPROM is combined with an infection. In the case of a PPROM without infection, tocolytics are prescribed to the pregnant woman in order to stop or prevent preterm labor. Steroids are another option in treating PROM; they help the fetus�s lungs to mature early in PPROM cases when preterm birth is not stopped.

Most experts agree that pregnant women must ensure they have informed consent of the treatment process in order to weigh the risks and benefits of each process. Participating in the process with their doctor is the best way for women experiencing difficulty during their pregnancy to feel in control and can help reduce increased stress when confronting PROM.


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