Risks of Pre-labour Rupture of Membranes
Definition
rupture of the membranes (amnion & chorion) containing amniotic fluid in a mother whose gestation is > 37 weeks and prior to the onset of labor. (PROM)
< 37 weeks - called preterm premature rupture of membranes (PPROM)
Incidence
8-10% of all births
Cause of 18% of perinatal daths
Associated with one third of all preterm births
Aetiology
Associated with low socioeconomic status
Low body mass index
Tobacco use
H/O preterm labor
Urinary tract infection
Vaginal bleeding at any time in pregnance
Cerclage
Amniocentesis
Smoking during pregnancy
Pathophysiology
At term Programmed cell death and activation of catabolic enzymes, such as collagenase and mechanical forces result in rupture of the membranes
In PROM it occurs due to the same mechanisms and premature activation of these pathways
PROM - may be caused by inflammation and/or infection of the membtanes
Symptoms and Signs of PROM
Leaking or a gush of watery fluid from the vagina
Constant wetness in the underwear
Cervix is seen leaking
pH of the fluid is acid or alkaline
Dried fluid under the microscope may show a characteristic fern-like pattern
USGM - shows a reduction of fluid around the fetus
Complications
Early delivery
Infection : post partum infection
Placental abruption
Treatment
Hospitalize
Expectant management - in very few cases of PPROM the membranes may seal over and the fluid may stop leaking without treatment
Monitor for signs of infection such as fever, pain, increased fetal heart rate and/or laboratory tests
Corticosteroids may be given to help maturity of the fetal lungs - steroids may mask signs of infection
Antibiotics
Tocolytics
If there are signs of abruption, chorioamnionitis or fetal compromise → do early delivery.
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