A premature rupture of membranes, also known as ‘water breaking’, usually occurs just before the onset of labor. If it occurs earlier than that, however, this is considered to be an at-risk pregnancy condition. While it is a fairly common problem, the premature rupture of membranes is a complication that could potentially be harmful for both the mother and the unborn baby.
Premature rupture of membranes is also known by the medical term PROM. It refers to a rupture or leak of fetal membranes (amniotic sac) before labor begins. It may happen at or after 37 weeks of gestation (Term PROM), or prior to 37 weeks gestation (Preterm PROM or pPROM).
Premature rupture of membranes—at or after 37 weeks—is found in approximately 10% of pregnancies, while preterm premature rupture of membranes—prior to 37 weeks—occurs in approximately 3% of all pregnancies.
Although the cause of premature rupture of membranes is not yet fully understood, and in many cases a specific cause is not found, there are still a number of significant related causes and risk factors that have been shown to increase the chance of it happening. These are:
Other risk factors include multiple pregnancies, polyhydramnios (excess of amniotic fluid in the amniotic sac), uterine fibroids, a history of cervical surgery, diagnosis of short cervical length, a history of sexually transmitted diseases, placenta previa, placental abruption (placenta partially or completely separates from the uterus before the baby is born), anemia, and the detection of fetal abnormalities.
What the doctor will be most concerned about is the infection of the mother, as the premature rupture of fetal membranes allows bacteria to get into the uterine cavity and cause this problem. This is related to the period of time between the membrane rupture and the delivery. Especially in cases of preterm premature rupture of membranes (prior to 37 weeks gestation), in addition to the baby being at risk of serious infection and long-term developmental disabilities, there is also the risk of other various complications as a result of the preterm birth, such as respiratory difficulties due to incomplete lung development, also known as (Respiratory Distress Syndrome). There may also be other complications resulting in abnormal functioning of the baby’s heart and lungs.
Diagnosis starts with taking a medical history to find out whether the patient has had symptoms of fluid gushing or leaking from the vagina or not. From there, a gynecological exam will allow the doctor to evaluate the vaginal fluid, whereby the doctor may ask the patient to cough or try a push so that the leakage of the fluid can be seen. Usually, doctors will not perform a pelvic examination at this stage as that can increase the risk of infection. Next, the vaginal fluid will be examined in the laboratory and an ultrasound scan may be used as well to add to and help confirm the diagnosis.
With regard to treatment, if the doctor determines that there is a premature rupture of the membranes and that it poses a risk, the patient is typically admitted to the hospital until the birth of the baby. The treatment approach depends on a variety of factors, including gestational age, infection of the pregnant mother, symptoms of labor, movement and heartbeat of the fetus, cervical dilation, etc. All these factors will be considered in determining the appropriate course of treatment.
Watchful care of a mother’s health during pregnancy is important and essential. Every pregnant mother should know that everything she does today can affect the health of her unborn baby, whether in small or great ways. No one wants to experience the frustrations of an at-risk pregnancy, and so it is critical for an expectant mother to begin prenatal care as early as possible in her pregnancy in order to ensure the safety of both mother and baby, and to provide the new baby with the very best start in life.
M.D., Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 1989.