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Premature Rupture of Membranes (PROM)/Preterm Premature Rupture of Membranes (PPROM)

What is premature rupture of membranes?

Premature rupture of membranes (PROM) is a rupture (breaking open) of the membranes (amniotic sac) before labor begins. If PROM occurs before 37 weeks of pregnancy, it is called preterm premature rupture of membranes (PPROM).

PROM occurs in about 8% to 10% of all pregnancies. PPROM (before 37 weeks) accounts for one-fourth to one-third of all preterm births.

What causes premature rupture of membranes?

Rupture of the membranes near the end of pregnancy (term) may be caused by a natural weakening of the membranes or from the force of contractions. Before term, PPROM is often due to an infection in the uterus. Other factors that may be linked to PROM include the following:

  • Low socioeconomic conditions (as women in lower socioeconomic conditions are less likely to receive proper prenatal care)

  • Sexually transmitted diseases, such as chlamydia and gonorrhea

  • Previous preterm birth

  • Vaginal bleeding

  • Cigarette smoking during pregnancy

  • Unknown causes

Why is premature rupture of membranes a concern?

PROM is a complicating factor in as many as one-third of premature births. A significant risk of PPROM is that most babies are born within a week of the membrane rupture. Another major risk of PROM is development of a serious infection of the placental tissues called chorioamnionitis. This can be very dangerous for mother and baby. Other complications that may occur with PROM include placental abruption (early detachment of the placenta from the uterus), compression of the umbilical cord, cesarean birth, and postpartum (after delivery) infection.

What are the symptoms of PROM?

The following are the most common symptoms of PROM:

  • Leaking or a gush of watery fluid from the vagina

  • Constant wetness in underwear

If you notice any symptoms of PROM, be sure to call your health care provider as soon as possible. The symptoms of PROM may look like other conditions medical problems. Always see your health care provider for a diagnosis.

How is premature rupture of membranes diagnosed?

In addition to a complete medical history and physical exam, PROM may be diagnosed in several ways, including the following:

  • An exam of the cervix (may show fluid leaking from the cervical opening)

  • Testing of the pH (acid or alkaline) of the fluid

  • Looking at the dried fluid under a microscope (may show a characteristic fern-like pattern)

  • Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess how much fluid is around the baby.

Treatment for premature rupture of membranes

Your health care provider will figure out the best treatment for you based on:

  • Your overall health and medical history

  • How well you can handle specific medications, procedures, or therapies

  • How long the condition is expected to last

  • Your opinion or preference

Treatment for preterm premature rupture of membranes may include:

  • Hospitalization

  • Expectant management (in very few cases of PPROM, the membranes may seal over and the fluid may stop leaking without treatment, although this is uncommon unless PROM was from a procedure, such as amniocentesis, early in gestation)

  • Monitoring for signs of infection, such as fever, pain, increased fetal heart rate, and/or lab tests.

  • Giving the mother medications called corticosteroids that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies). However, corticosteroids may mask an infection in the uterus.

  • Antibiotics (to prevent or treat infections) and to prolong the time to delivery

  • Tocolytics. Medications used to stop preterm labor.

  • Women with PPROM usually are induced to deliver at 34 weeks if stable. If there are signs of abruption, chorioamnionitis, or fetal compromise, then early delivery would be necessary.)

Prevention of premature rupture of membranes

Unfortunately, there is no way to actively prevent PROM. However, this condition does have a strong link with cigarette smoking and mothers should stop smoking as soon as possible.

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