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Risks of Pre-labour Rupture of Membranes
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)

8-10% of all births
Cause of 18% of perinatal daths
Associated with one third of all preterm births

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
Smoking during pregnancy

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

Early delivery
Infection : post partum infection
Placental abruption

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
If there are signs of abruption, chorioamnionitis or  fetal  compromise do early delivery.

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