Premature Rupture Of Membranes

What is premature rupture of membranes?

• Premature rupture of membranes (PROM) is a condition in which fluid leaks from your amniotic sac before labor begins. Labor is when you begin having contractions (uterus tightens and relaxes) in order to deliver (push out) your baby. Your amniotic sac is located in your uterus (womb) and holds your unborn baby. The amniotic sac contains fluid that cushions your baby and allows him to move around. This fluid also takes away his body waste and helps to protect him from infection. Usually, the membranes (amniotic sac tissue) rupture and cause the fluid to leak out after labor has started. Ask your caregiver for more information about labor.
  
  
• PROM can happen very close to your due date, or it can happen earlier in your pregnancy. With PROM, you are likely to deliver your baby soon, often within a few hours or days. When PROM happens before 37 weeks, it is called preterm PROM (PPROM). PROM and PPROM can cause serious health problems for you, such as infection. It can also cause problems for your unborn baby, such as difficulty breathing. PROM that happens close to your due date may not cause any problems. With treatment, you have a better chance of having a safe delivery. Treatment may also prevent problems for you and your baby.

What causes premature rupture of membranes?

The causes of PROM are not completely understood, but certain factors may increase your risk. Being underweight (weighing less than caregivers suggest), smoking, using drugs, or drinking alcohol (such as beer, wine, or whiskey) may increase your risk. If you have any of the following, you may also be more likely to have PROM:

• Amniocentesis: During amniocentesis, a needle is placed inside your amniotic sac to take out a small amount of fluid. The fluid is sent to a lab to check your baby's health. After this procedure, you may have PROM because of fluid leaking from the hole that the needle made. With time, fluid leakage 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 womb). This procedure is done to keep your cervix closed until the baby is ready to be born. Your risk of PROM may be higher if you have had this procedure. You are also more likely to get PROM if you have had surgery on your cervix.
  
  
• Contractions: Before giving birth, your body prepares 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.
  
  
• Infection: Infections of the uterus can increase your risk of PROM. Infections may include sexually transmitted diseases such as herpes, chlamydia, or gonorrhea. Urinary tract infections also increase your risk. You may have an infection without having signs or symptoms. Caregivers may do tests to see if you have an infection and what may be causing the infection.
  
  
• Medical conditions: Some medical conditions such as lung disease and Ehlers-Danlos (a connective tissue disorder) can increase the risk of PROM. Having low levels of nutrients such as vitamin C and copper may also lead to PROM. If you have a medical condition, talk to your caregiver about how to manage it during pregnancy.
  
  
• Problems with your pregnancy: Some pregnancy problems can increase your risk of PROM. Having too much or too little amniotic fluid can increase your risk. You may develop PROM if your placenta starts to separate from the lining of your uterus. The placenta provides oxygen and food to your baby during pregnancy. Bleeding from your vagina in the second and third trimester may also make you more likely to have PROM. If you have had preterm labor symptoms, such as contractions, your risk of PROM is increased.
  
  
• Other: Your risk of PROM also increases if you are pregnant with more than one baby, such as twins. PROM is also more likely to happen if this pregnancy began six months or less after your last pregnancy. Having a premature delivery or PROM in an earlier pregnancy may also increase your risk.

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: Caregivers insert a swab into your vagina to take a fluid sample. Caregivers do a lab test to see if the fluid is amniotic fluid. The fluid may also be tested to show if you are likely to deliver your baby soon.
  
  
• Indigo carmine dye test: Caregivers will insert a blue dye into the amniotic fluid in your uterus using amniocentesis. Caregivers insert this dye into your uterus to see if it comes out of your vagina. They will ask you to wear a peripad (pad that absorbs fluid) for this test. If the blue dye shows on the peripad, caregivers know that your membranes have ruptured. They may also do another vaginal exam.
  
  
• Vaginal exam: During a vaginal exam, your caregiver will put a speculum into your vagina. A speculum is a tool that opens your vagina so your caregiver can see your cervix (bottom part of your uterus). He will look for fluid leaking out of your cervix or fluid in your vagina. He can also see if your cervix is dilating (starting to open). He may also check your cervix with a gloved finger if he thinks you are in labor.

What other tests may I need?

• Amniocentesis: Caregivers may do an amniocentesis to check if you have an infection in your womb.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Cultures: Cultures may be done to check for urine or vaginal infections such as a urinary tract infection or chlamydia. Cultures can show what germs are causing the infection so caregivers know what type of medicine to give you.
  
  
• Fetal biophysical profile: A fetal biophysical profile is a test that combines the nonstress test and a special ultrasound of your unborn baby. The nonstress test measures changes in your baby's heartbeat during movement. The ultrasound will show your baby's movement, how his muscles are working, and the amount of fluid around him. It will also show if your baby's breathing muscles are working.
  
  
• 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: This test uses sound waves to show pictures of your unborn baby inside your uterus. Jelly-like lotion is put on your abdomen, and a small handle is gently moved through the lotion. As this is done, pictures of your baby can be seen on a TV-like screen. Caregivers can check the growth and age of your baby. The movement, heart rate, and position of your baby can also be seen. Caregivers can see how much fluid is in your womb and check your placenta.
  
  
• Lung maturity test: Caregivers may 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 from your vagina. They can also test amniotic fluid from your womb by doing an 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.

How is premature rupture of membranes treated?

You may need special treatment and medicines for your PROM or PPROM. Treatment depends on your unborn baby's age, his health, and how strong his lungs are. Caregivers will talk with you about the best treatment for you and your baby. Your caregiver may send you to a special hospital so that you can get the treatment that you need. Treatment may include any of the following:

• Bed rest: Your caregiver may order bed rest for you. He will ask you to rest in bed most of the time. You may be able to get up to use the bathroom. Ask your caregiver if there are other things you can get up and 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.
  
  
• Delivery: Your caregiver may decide to deliver your baby if he is ready to be born. He may also deliver your baby if you have an infection or problems with the pregnancy. Your caregiver may also deliver your baby if his health is in danger. You may be able to have a vaginal birth, or you may need a Cesarean section (C-section). A C-section is a surgery that is done to take out your baby safely through a cut in your abdomen.
  
  
• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Blood thinners: If you are on bed rest, you may need to take blood thinning medicine. This medicine helps to stop clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may make it easier to bleed or bruise. While taking this medicine, use a soft toothbrush to prevent bleeding gums. If you shave, use an electric shaver.
    
    
  • Oxytocin: This medicine may be used to start your labor by starting contractions. It can also help your contractions stay strong and regular so that your baby is born safely. It may be used at any time after your membranes have ruptured.
    
    
  • Steroid medicine: If your water breaks or labor starts before your baby is ready to be born, you may be given steroid medicine. This may be needed when you have been pregnant for only 23 to 34 weeks. The steroids may help your unborn baby's lungs develop faster before he is born.
    
    
  • Tocolytics: Tocolytics are medicines that stop contractions. You may need this medicine if your baby is not ready to be born and you are having contractions.

What are the risks of having and treating premature rupture of membranes?

• With PROM, you may get an infection in your womb. The infection may spread to your baby or to the rest of your body and cause serious health problems. The decreased amount of amniotic fluid may cause your unborn baby to press on his umbilical cord. This can cut off his blood supply and cause serious health problems. The placenta may separate from the walls of your uterus, causing bleeding. This blood loss may be life-threatening for you and your unborn baby. Part of your placenta may stay attached to your uterine wall. You may need a dilation and curettage (D and C) to remove parts of the placenta that do not come out.
  
  
• You may have an allergic reaction to medicines used to treat you. If you are on bed rest, you have a greater chance of getting a blood clot. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot may break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Your baby may be born premature (before 37 weeks) and have health problems. If your baby is born before his lungs are formed, he may have trouble breathing. He may also have other problems with his lungs, such as pneumonia (lung infection). His intestines (gut) may not work normally. He may get an infection, have bleeding in his brain, or he may die. Your baby may not be in a head-down position, which can make it harder to deliver him. Caregivers may need to do a C-section to deliver your baby. Talk to your caregiver about questions or concerns that you have about your condition, care, or treatment.

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

• Do not smoke or drink alcohol (such as beer, wine, or whiskey).
  
  
• Do not use street drugs.
  
  
• Eat a healthy diet and gain the amount of weight suggested by your caregiver.

Where can I get more information about premature rupture of membranes?

Contact the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• The American College of Obstetricians and Gynecologists
  409 12th Street, SW
  Washington , DC 20090
  Phone: 1- 202 - 638-5577
  Web Address: http://www.acog.org
  

When should I call my caregiver?

Call your caregiver if:

• You have discharge from your vagina that smells bad.
  
  
• You have a fever.
  
  
• Your uterus feels tender (painful to the touch).
  
  
• 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 help?

Call 911 or go to an emergency room if:

• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You feel a gush or trickle of fluid leaking from your vagina.
  
  
• You are bleeding from your vagina.
  
  
• You have strong stomach pains in your abdomen.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths 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.

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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.