What is premature rupture of membranes?
Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM).
PROM occurs in about 8 to 10 percent of all pregnancies. PPROM (before 37 weeks) accounts for one fourth to one third of all preterm births.
What causes premature rupture of membranes?
Rupture of the membranes near the end of pregnancy (term) may be caused by a natural weakening of the membranes or from the force of contractions. Before term, PPROM is often due to an infection in the uterus. Other factors that may be linked to PROM include the following:
Low socioeconomic conditions (as women in lower socioeconomic conditions are less likely to receive proper prenatal care)
Sexually transmitted infections, such as chlamydia and gonorrhea
Previous preterm birth
vagin*l bleeding
Cigarette smoking during pregnancy
Unknown causes
Why is premature rupture of membranes a concern?
PROM is a complicating factor in as many as one third of premature births. A significant risk of PPROM is that the baby is very likely to be born within a few days of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis, which can be very dangerous for mother and baby. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum (after delivery) infection.
What are the symptoms of PROM?
The following are the most common symptoms of PROM. However, each woman may experience symptoms differently. Symptoms may include:
If you notice any symptoms of PROM, be sure to call yourdoctor as soon as possible. The symptoms of PROM may resemble other medical conditions. Consult your doctor for a diagnosis.
How is premature rupture of membranes diagnosed?
In addition to a complete medical history and physical examination, PROM may be diagnosed in several ways, including the following:
An examination of the cervix (may show fluid leaking from the cervical opening)
Testing of the pH (acid or alkaline) of the fluid
Looking at the dried fluid under a microscope (may show a characteristic fern-like pattern)
Ultrasound. A diagnostic imaging techniquethat uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess how much fluid is around the baby.
Treatment for premature rupture of membranes
Specific treatment for PROM will be determined by your doctor based on:
Your pregnancy, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment for premature rupture of membranes may include:
Hospitalization
Expectant management (invery fewcases of PPROM, the membranes may seal over and the fluid may stop leaking without treatment, although this is uncommon unless PROM was from a procedure, such as amniocentesis, early in gestation)
Monitoring for signs of infection, such as fever, pain, increased fetal heart rate, and/or laboratory tests.
Giving the mother medications called corticosteroids that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies). However, corticosteroids may mask an infection in the uterus.
Antibiotics (to prevent or treat infections)
Tocolytics. Medications used to stop preterm labor.
Women with PPROM usually deliver at 34 weeks if stable. If there are signs of abruption, chorioamnionitis, or fetal compromise, then early delivery would be necessary.)
Prevention of premature rupture of membranes
Unfortunately, there is no way to actively prevent PROM. However, this condition does have a strong link with cigarette smoking and mothers should stop smoking as soon as possible.
FAQs
Sometimes the membranes break before a woman goes into labor. When the water breaks early, it is called premature rupture of membranes (PROM). Most women will go into labor on their own within 24 hours. If the water breaks before the 37th week of pregnancy, it is called preterm premature rupture of membranes (PPROM).
What is premature rupture of membranes and preterm premature rupture of membranes? ›
Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM).
What is PROM in premature rupture of membranes? ›
Premature rupture of membranes (PROM) is the rupture of gestational membranes prior to the onset of labor. When membrane rupture occurs before 37 weeks of gestation, it is referred to as preterm PROM (PPROM).
What do you do if you have a premature rupture of membranes? ›
Treatment for preterm PROM (less than 34 weeks pregnant)
Your provider will keep you in the hospital on bed rest and attempt to prolong the pregnancy. They may also give you: Corticosteroids to help develop the fetus's lungs. Antibiotics to prevent infection and prolong the pregnancy.
What is the most common cause of preterm premature rupture of membranes? ›
Clinical factors associated with preterm PROM include low socioeconomic status, low body mass index, tobacco use, preterm labor history, urinary tract infection, vagin*l bleeding at any time in pregnancy, cerclage, and amniocentesis.
How long can you go with premature rupture of membranes? ›
(Premature Rupture of Membranes)
If labor does not begin within 6 to 12 hours, the risk of infections in the woman and fetus increases. If labor does not start soon after the membranes rupture and the pregnancy is 34 weeks or more and the fetus's lungs are mature, labor is usually started artificially (induced).
Can a baby survive premature rupture of membranes? ›
A recent study reports a 90% survival rate for infants exposed to prolonged PPROM occurring between 18-24 weeks who were delivered after 24 weeks.
How likely is PPROM to happen again? ›
However, the identified risk of recurrent PPROM at <37 weeks gestation (n=4 studies, 3138 women) was 7% (95% CI 6% to 9%) with an I2 of 51% and the risk of recurrent PTL at <37 weeks' gestation (n=3 studies, 2852 women) was 23% (95% CI 13% to 33%) with an I2 of 97.3% (figure 3).
What is the most common cause of PROM? ›
In most cases, the cause of PROM is unknown. Some causes or risk factors may be: Infections of the uterus, cervix, or vagin*. Too much stretching of the amniotic sac (this may happen if there is too much fluid, or more than one baby putting pressure on the membranes)
What are the odds of PPROM recurrence? ›
Women with PPROM before 27 weeks' gestation without contractions have a strongly increased risk of preterm birth in the next pregnancy. The risk of recurrence of PPROM before 37 weeks is 20% and the risk of preterm delivery is 40%.
During pregnancy, your baby is surrounded and cushioned by a fluid-filled membranous sac called the amniotic sac. Typically, at the beginning of or during labor your membranes will rupture — also known as your water breaking. If your water breaks before labor starts, it's called prelabor rupture of membranes (PROM).
Can stress cause premature rupture of membranes? ›
Maternal second-trimester stress is associated with a higher risk of PROM and it is significant in pregnant women with normal pre-pregnancy BMI.
How do I tell if I have PPROM? ›
Call your healthcare provider right away if you have signs of PPROM. These include a sudden gush of fluid from your vagin*, leaking of fluid, or a feeling of wetness in your vagin* or underwear.
What is a major threat after preterm rupture of membranes? ›
Fetal complications after membrane rupture include infection and fetal distress due to umbilical cord compression or placental abruption. Because of these factors, women with PROM have a higher risk of cesarean delivery for non-reassuring fetal heart rate.
What does PROM feel like? ›
Patients with preterm PROM often report a sudden gush of fluid that keeps leaking. Some patients will wake up feeling wet or with fluid all over the bed. Sometimes they feel like they urinated on themselves or can't stop the flow when they go to the bathroom.
What is the difference between spontaneous rupture of membranes and premature rupture of membranes? ›
Spontaneous rupture of membranes (ROM) is a normal component of labor and delivery. Premature ROM (PROM) refers to rupture of the fetal membranes prior to the onset of labor irrespective of gestational age.
What is the survival rate for PPROM? ›
included pregnancies complicated by PPROM between 20 and 24 weeks gestation and found an overall survival rate of 6.25 % [3]. Survival was 40, 92 and 100 % of those experiencing PPROM at 14–19, 20–25 and 26–28 weeks respectively by Farooqi et al. [5].
Is premature rupture of membranes the same as water breaking? ›
Typically, at the beginning of or during labor your membranes will rupture — also known as your water breaking. If your water breaks before labor starts, it's called prelabor rupture of membranes (PROM). Previously it was known as premature rupture of membranes.
What does a positive fern test mean? ›
Negative: No crystallization seen (membranes are not ruptured) Positive: Crystallization seen (membranes are ruptured) Clinical Significance. The correct diagnosis of rupture of the membranes (PROM) during pregnancy is of great importance.
