If the amniotic membranes rupture before week
37, it is considered to be preterm premature rupture
of the membranes or PPROM. An uncontrollable gush
or gradual leak of liquid occurs before the onset
of labor, in some cases much before baby reaches
term. In the past due to overwhelming concern
for the mother and baby incurring infection due
to prolonged rupture, babies were delivered when
the rupture occurs regardless of gestational age.
Today things are different and the actions taken
after a PPROM without labor are either:
• A wait and see approach for labor to commence;
meanwhile both mother and baby will be monitored
continuously. Maternal temperature will be observed
and vaginal examination will be totally avoided
• or corticosteroid therapy will be initiated
to stop labor (medication may or may not be given)
The Facts..
• Miscarriage is a possibility if PPROM
occurs before 20 weeks of pregnancy
• Premature delivery is a viable consequence
if PPROM occurs after 20 weeks of pregnancy
• When membranes rupture, labor usually
ensues. The closer the due date, the sooner labor
is likely to begin
• PPROM poses a greater risk if it happens
preterm, before baby is ready to be born. Since
the fetus is not ready to live in the outside
world, efforts will be made to keep the pregnancy
going
• The mother needs to be hospitalized if
premature rupture occurs irrespective of her being
in labor or not for the medical staff to determine
the cause and if delivery is imminent
• PPROM usually is a result of weakened
membranes that have lost its elasticity
• The probable but not conclusive cause
is bacterial infection; common invading bacteria
are thought to be group B streptococcus (GBS),
bacterial vaginosis (BV) among others
• If baby is 26 weeks or older the survival
rate is high; a course of corticosteroids will
be given to mature up baby's lungs quicker while
it is still inside
• Delivery may be postponed anywhere from
a few hours to a few weeks
• A close watch will be kept in a hospital
setting with total bed rest
The Treatment..
• Correct diagnosis will be made before
any treatment; a combination of history, physical
exam to confirm the presence of amniotic fluid
in the vagina, ultrasound to check on fluid level
and lab tests will be carried out
• Treatment will depend on amniotic fluid
level, if mother is at risk of getting an infection
and the gestational age of the fetus
• Vaginal fluid will be taken and cultured
to check for infection. Since results may take
up to 48 hours, the mother may be started on antibiotics.
Symptoms of infection may not manifest early enough
• The fluid quantity will be measured via
an ultrasound
• Pregnancy will continue if the quantity
is sufficient
• A small tear in the upper part of the
uterus called 'high leak' usually means a small
trickle of fluid is let out. However the status
can change to continuous flow leading to premature
labor
• Alternatively the tear can heal on its
own, the leak will stop and pregnancy may continue
to full term
• The mother will still be monitored carefully
to watch out for infections
• Usually the mother will be discharged
with a prescription for bed rest depending on
certain other conditions besides the above. These
conditions include:
1. the baby should be in a vertex
position,
2. there should be no sign of
infection,
3. the mother should be able
to rest,
4. abstinence from vaginal intercourse,
5. maternal temperature should
be observed while at home
6. mother must return for prenatal
visits minimum on a weekly basis
• Sometimes in the event of an infection
occurring your doctor may decide on prompt delivery
When Delivery is imminent..
• In the presence of maternal fever, infection
is very probable. Delivery will be induced. Most
cases of PPROM go into labor either immediately
or within 48 hours.
• Many doctors will induce if the fetus
is at term or near term following a rupture
•
Otherwise induction only happens if there is an
infection
• In situations when the infection is serious,
the general consensus will be that baby be delivered
within 12 hours, never mind if baby is premature
• Another complication is the possibility
of a C-section. If the rupture occurs without
contractions it usually implies that the cervix
is not open so an operation becomes inevitable
• Infection of the amniotic sac results
in either PPROM or other pregnancy complications.
• Bacteria that is initially found in the
vaginal fluids starts to multiply and travel up,
crossing into the uterus. These bacteria may spread
to the sac and the baby
• Treatment with antibiotics becomes mandatory
