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Preterm Premature Rupture of Membranes (PPROM)

PREGNANCY

Evidence

https://www.ncbi.nlm.nih.gov/books/NBK532888/

Shailja Dayal; Peter L. Hong.

Prelabour rupture of membranes (PROM) is defined as rupture of membranes before the onset of labour. When membrane rupture occurs before labour and before 37 weeks of gestation, it is referred to as preterm PROM (PPROM).

Education

Your baby lies in an amniotic sac of fluid sometimes referred to as 'waters'. If your waters break before labour begins it is called Premature Rupture of Membranes (PROM). If PROM occurs before your baby has reached 37 weeks gestation, the medical term is Preterm Premature Rupture of Membranes (PPROM)

PPROM may lead to spontaneous delivery of your baby within hourshours, or it may be weeks until your baby is born. A large proportion of women will go into labour within 7 days of their membranes rupturing. You may be confined to hospital to monitor your pregnancy and prevent complications, or your doctor may allow you to return home depending on your condition. There may be no known cause for your PPROM, however there are some factors that can increase your risk of the condition, these are:

Infections in your reproductive system
Previous preterm birth
Short cervical length
Vaginal bleeding
Invasive uterine procedures such as amniocentesis
Inadequate antenatal care
Smoking during pregnancy
Illicit drug use

The symptoms associated with PPROM are:

Slow leak or gushing of fluid from the vagina
Wetness in underwear

PPROM is usually diagnosed based on the history you give as well as a speculum examination of the vagina and a swab that can detect the presence of amniotic fluid.

If you are diagnosed with PPROM you may need to prepare yourself for the following:

Preterm labour and delivery
Infection
Bleeding
Compression of the umbilical called (umbilical cord prolapse)
Placental abruption (where the placenta separates from the wall of the uterus)

Although there is no cure for PPROM, there are ways to treat the condition.The treatment will depend on your gestation, pregnancy, general health and the severity of your symptoms.

Treatment may include:

Hospital stay and bed rest to monitor you for signs of labour, signs of maternal infection and monitoring you baby’s heart rate and movements
Antibiotics to treat or prevent an infection \
Corticosteroids to help grow and mature your baby’s lungs in case of a premature birth
Medication to stop labour
Delivery of the baby. Labour may be induced or a caesarean may be indicated, particularly if the baby isn’t in the head down position.This depends on many factors and your treating team will discuss this with you.

You will likely be reviewed by a specialist neonatal (baby) doctor to discuss the implications of PPROM at your gestation.They will be able to give you more information on outcomes for your baby.

Empowerment

It is not unusual for women to mistake the leaking of amniotic fluid for urine, especially when it leaks slowly. If you notice any symptoms or think your membranes may have ruptured call your primary health care provider immediately. They may ask you some of the following questions:

What time did your membranes rupture?
Are you wearing a pad or having to sit on a towel?
What is the volume, colour and odour of the fluid?
Have you felt contractions?
Do you feel unwell?
Have you felt your baby moving normally?
Have you had any medical problems in your pregnancy?
Are you experiencing any bleeding?
Have you experienced any trauma or engaging in physical activity?

Once PPROM is confirmed by your doctor the length of time before labour commences can be influenced by many factors. Generally, women with PPROM have a 50% chance of labour starting within 24 to 48 hours and a 70-90% chance of going into labour within seven days. If PPROM occurs between 24- and 28-weeks gestation, the length of time before birth is generally longer than if occurring closer to full term.

Depending on your gestation and current health condition, you may be transferred to a tertiary hospital if your current hospital is unable to deliver a preterm baby. This may evoke feelings of worry, anxiety and fear for you and your baby’s future. Asking questions such as treatments, prognosis and what to expect of a preterm baby at your gestation may help you feel more informed. Ask to visit the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) to become familiar with the experience and environment.