To begin with, premature rupture of membranes is a condition pertaining to pregnancy. The fetus in mother’s womb is surrounded by amniotic fluid (water). Amniotic fluid acts as a cushion to protect the developing fetus. There is a membrane which holds the fetus and amniotic fluid. This membrane normally breaks at the time of labor. However, in many women the membrane breaks before the labor begins, but after 37 weeks. As a result the fluid inside the amniotic sac leaks out or gushes out from the cervix. It is also called “breaking of water”.
Here, there is a slight variance that needs to be mentioned. When the rupture of membranes occurs before 37 weeks the condition is called preterm premature rupture of membranes. The unfavorable effects are mainly observed when it happens in premature pregnancy (before 37 weeks).
PROM increases the risk of pregnancy related complications which include infection in uterus, premature birth and prolapsed umbilical cord. In view of this, it is important for a pregnant woman to inform her doctor when she suspects that her bag of water is broken.
Causes Of Premature Rupture Of Membranes
The cause of premature rupture of membranes is not very well understood.Some of the conditions that are believed to favor it are as follows:
- Friability of the membrane in premature labor.
- Infection in uterus and vagina. This may include sexually transmitted disease.
- Dilatation of cervix before the due date. It can be either due to weight of baby and placenta or any abnormality in the cervix itself.
- Poor nutritional status, which is commonest cause in poor social class patients.
- Uterus is overstretched due to excess of amniotic fluid or due to multiple fetuses.
- Smoking cigarettes.
- Increased risk if there is history in earlier pregnancies.
- History of cervical surgery in past.
Premature Rupture Of Membranes Symptoms
- The main symptom is leakage or gushing of amniotic fluid from the vaginal opening. The pregnant woman may give a history of popping sensation and thereafter gush of fluid from the vagina.
- If the leak is small, the characteristic color of fluid can be detected in the sanitary pad worn by the woman for few hours.
- Sometimes the dribbling of fluid from vagina may be difficult to distinguish from amniotic fluid. In such cases, simple tests done by the doctor can determine it.
- In the doctor’s office, he can see the escape of liquor from cervix by inserting a sterile speculum in the vagina.
- With PROM, the chance of infection increases. Fever is present. There is tenderness of abdomen.
Treatment For Premature Rupture Of Membranes
The treatment of premature rupture of membrane depends on the time of its rupture. This means does it occur close to the due date or it occurs few weeks earlier than the due date of delivery.
If PROM is near the due date, the patient is hospitalized and observed for 24 hours. In absence of any labor signs, the patient is administered medicines to induce labor.
In case if the bag of waters is broken between 34 to 37 weeks, the doctor usually administers medicine to induce labor. This is to reduce the risk of infection and complication. A baby born few weeks earlier can be managed than an infection in the uterus.
In case if PROM is in very early stage of third trimester, the physician will do his best to postpone labor till suitable time. This is done to make baby’s lung strong. Antibiotics are administered as a prophylaxis treatment to prevent infection. Once the doctor finds the baby’s lung have matured, he will try to induce labor.
If the patient already has intrauterine infection with a history of prolonged rupture of membranes, and the patient is not in labor, the size of fetus is reasonable and fetal heart sound is still audible than cesarean section delivery is done under cover of high doses of antibiotics.