PPROM pregnancy : Premature rupture of membranes
Premature rupture of membranes : Pregnancy complications in the mother
In about 3% of pregnancies, the amniotic membrane or "water bag" ruptures and releases amniotic fluid before 37 weeks of amenorrhea. Premature rupture of membranes is not necessarily accompanied by contractions, but remains responsible for 30% of preterm births.
Complications associated with premature rupture of membranes include:
- Chorioamnionitis causing preterm labor and preterm delivery;
- Chorioamnionitis causing fetal distress and perinatal death;
- A cord injury secondary to severe oligohydramnios (low amniotic fluid) or cord prolapse;
- Placental abruption causing premature delivery;
- Pulmonary hypertension and pulmonary hypoplasia causing severe breathing difficulties in the premature newborn if rupture of membranes occurs during the 2nd trimester of pregnancy.
These complications are avoided by close medical monitoring and by administering
treatments specific to these conditions.
Causes
The cause of rupture of membranes is not always identifiable. However, it may be the result of a medical procedure (e.g., amniocentesis), a genital infection of the mother, or the amniotic fluid itself. Certain pregnancy complications leading to overdistention of the uterus (e.g., polyhydramnios, which is a significant excess of amniotic fluid) may also be associated with preterm premature rupture of membranes.
Symptoms to watch for
Obvious loss of clear, watery or colored fluid, profuse or dripping repeatedly from the vagina before term should be promptly reported to a member of the medical team. Occasionally, a pregnant woman will experience urinary leakage, but the difference is identifiable by its color and odor.
Tests and procedures
When premature rupture of membranes is suspected, the doctor will perform certain tests to confirm it:
- Fern test or fern test; examination under a microscope;
- Nitrazine paper;
- Amnisure;
- Ultrasound.
If the tests are conclusive, blood and vaginal samples will be taken
from the mother in order to study the reason and rule out chorioamnionitis.
Since fetal well-being is very important, the following tests will complete the examination:
- Fetal reactivity assessment (ERF or NST);
- Biophysical profile if necessary;
- Listening to the fetal heart with a portable monitor when the pregnancy is less than 23 weeks.
Treatments and follow-ups
When membranes rupture prematurely, evaluation by a physician
is necessary.
The proposed treatment will be chosen based on:
- of gestational age;
- fetal well-being;
- signs of infection;
- the start of labor (contractions) or not.
According to the observations:
- In about 50% of cases, labor sets in and delivery occurs within 24 to 48 hours ;
- In more than 40% of cases, delivery occurs after 48 hours;
- In almost 10% of cases, the pregnancy is prolonged for a week or more.
When the membranes are ruptured, but there is no labor or infection:
- When the gestational age is less than 23 weeks, there will be investigation by a doctor. If the patient's condition is stable, he will prescribe rest at home with antibiotics and medical visits every two weeks with ultrasound;
- At 23 weeks of pregnancy and more, there will be hospitalization for at least one week, with administration of antibiotics, blood tests and ultrasound. To prevent the risk of respiratory distress in the baby, 2 injections of betamethasone will be given 24 hours apart. Finally, the doctor will request a weekly NST, regular temperature taking and will prescribe rest.
