Premature Rupture Of Membranes

What is premature rupture of membranes?

Premature rupture of membranes (PROM) is a condition where fluid leaks from your amniotic sac before labor begins. The amniotic sac contains fluid that surrounds and protects your unborn baby in your uterus. PROM may happen just before birth. If PROM happens before 37 weeks of pregnancy, it is called preterm PROM.

What increases my risk of premature rupture of membranes?

Your risk of PROM increases if you are pregnant with more than one baby. PROM is also more likely to happen if your pregnancy began less than 6 months after your last pregnancy. Your risk is also higher if you have had PROM or premature delivery in a previous pregnancy. The following may also increase your risk of PROM:

  • Contractions: Your body prepares for birth by having contractions. Contractions put pressure on the amniotic sac and may cause it to tear. Sometimes these contractions are happening, but you are not aware of them.

  • Amniocentesis: A needle is placed inside your amniotic sac to remove a small amount of fluid and check your baby's health. After this procedure, you may have fluid leak from the hole where the needle was inserted. With time, the fluid leak may stop because the hole can close on its own.

  • Cerclage or surgery on your cervix: Cerclage is a procedure in which a large stitch is placed in your cervix (opening of the uterus). It is done to keep your cervix closed until your baby is ready to be born. You are also more likely to get PROM if you have had surgery on your cervix.

  • Infection: A urinary tract infection or sexually transmitted infection (STI) can increase your risk of PROM.

  • Medical conditions: Some medical conditions, such as lung disease and Ehlers-Danlos syndrome, can increase the risk of PROM. If you are underweight or have low levels of nutrients, such as vitamin C and copper, your risk of PROM is increased.

  • Problems with your pregnancy: These may include too much or too little amniotic fluid, separation of your placenta from your uterus, bleeding, or contractions.

  • Exposure to harmful substances: These include smoking or using drugs or alcohol during pregnancy.

What are the signs and symptoms of premature rupture of membranes?

You may feel a gush of warm fluid or a slow trickle of fluid from your vagina.

How is premature rupture of membranes diagnosed?

Your caregiver will ask you about your medical history and your current symptoms. Other tests may include the following:

  • Vaginal fluid swab: A sample of fluid is taken from your vagina to see if it is amniotic fluid. The fluid may show if you are likely to deliver your baby soon.

  • Dye test: During this procedure, caregivers will insert a blue dye into the amniotic fluid using amniocentesis. You will wear a pad and wait to see if the blue dye comes out of your vagina. If blue dye shows on the pad, caregivers know that your membranes have ruptured.

  • Vaginal exam: This is done to learn if you are leaking amniotic fluid. In a vaginal exam, caregivers may be able to see if your cervix is dilating (starting to open). Caregivers will check your cervix if they think you are in labor.

What other tests may I need?

  • Cultures: These may be done to check for urine or vaginal infections. Cultures can show what germs are causing the infection so caregivers know what type of medicine to give you.

  • Fetal monitoring: Caregivers may monitor your baby's heartbeat and the contractions of your uterus. Monitoring allows your caregiver to check your baby's heart rate. He can also tell if there may be a problem, such as your baby pressing on the umbilical cord. Monitoring also allows your caregiver to see if you are having contractions that you do not feel.

  • Fetal ultrasound: An ultrasound uses sound waves to show pictures of your unborn baby on a monitor. An ultrasound may be done to check how much amniotic fluid is remaining and to check your placenta.

  • Lung maturity test: This is done to check the development of your baby's lungs to see if he is ready to be born. Caregivers may do this by testing a small amount of the leaking amniotic fluid or by amniocentesis.

  • Nonstress test (NST): This test is a simple way for your caregiver to check how your baby is doing. It uses a fetal heart monitor to watch your baby's heart rate. A baby's heart rate usually increases when he moves around or when your uterus has a contraction. A contraction is when the muscles of your uterus tighten and loosen. You may sit in a reclining chair or with the head of your bed raised during this test. Your caregiver may ask you to stand up or move around during the test. You may need this test more than once.

  • Amniocentesis: Caregivers may do an amniocentesis to check if you have an infection in your uterus.

How is premature rupture of membranes treated?

Treatment depends on your unborn baby's age, his health, and if his lungs are developed. Treatment may include any of the following:

  • Bed rest: This includes reducing your activities. It may also mean that you have to rest in bed for most of the day. Ask your caregiver what you can and cannot do.

  • Pelvic rest: Pelvic rest means that you should not put anything in your vagina, such as a tampon. This also means that you should not have sex.

  • Medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Oxytocin: This is used to start labor. It causes contractions to start and stay strong and regular. It may be used at any time after your membranes have ruptured.

    • Tocolytics: This is given to stop contractions. You may need this medicine if your baby is not ready to be born and you are having contractions.

    • Steroid medicine: This is given between 23 and 34 weeks to help your unborn baby's lungs develop faster.

  • Delivery: If your baby is old enough, caregivers may recommend that you deliver your baby. It also may be done if your baby's health is at risk. You may be able to have a vaginal birth, or you may need a Cesarean section. This is surgery to remove your baby through an incision in your abdomen.

What are the risks of premature rupture of membranes?

  • You may get an infection that may spread to your baby or to other parts of your body. The placenta may separate from the walls of your uterus and cause bleeding. This blood loss may be life-threatening for you and your unborn baby. You may get a blood clot in your leg or arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. You may need a dilation and curettage (D and C) to remove parts of the placenta from your uterine wall.

  • PROM may cause your unborn baby to press on his umbilical cord and cut off his blood supply. If your baby is born before his lungs are formed, he may have trouble breathing, pneumonia, or other lung problems. PROM may cause your baby to have other life-threatening conditions. Your baby may not be in a head-down position, which can make it harder to deliver him. Caregivers may need to do a Cesarean section to deliver your baby.

How can I decrease my risk of premature rupture of membranes?

  • Do not smoke or drink alcohol.

  • Do not use illegal drugs.

  • Eat healthy foods and gain the amount of weight suggested by your caregiver.

When should I contact my caregiver?

Contact your caregiver if:

  • You have discharge from your vagina that smells bad.

  • You have a fever.

  • Your uterus feels tender.

  • You feel your heart beating very fast.

  • Your weight is staying the same, or you are losing weight.

  • You have questions or concerns about your pregnancy or medicine.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You feel a gush or trickle of fluid leaking from your vagina.

  • You are bleeding from your vagina.

  • You have strong pains in your abdomen.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

  • You suddenly feel lightheaded and short of breath.

  • You have chest pain when you take a deep breath or cough. You may cough up blood.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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