PROM- Premature Rupture Of Membranes

The act of your water breaking is when the amniotic sac ruptures leaking out amniotic fluid. The amniotic fluid is what surrounds your baby while in the womb. The amniotic fluid helps your baby move freely, cushions them in the womb, helps develop their respiratory system and digestive system. Usually your water will break and within 24 hours you will be in active labor. In some cases you will be in active labor but you may need assistance from your healthcare provider to rupture the membranes allowing the amniotic fluid to come out. If your amniotic sac ruptures and labor does not follow it can put mother and baby at a higher risk of infection, and can raise the risk of premature birth.

PROM, or prelabor rupture of the membranes, happens when the amniotic sac ruptures but labor follows within 24 hours. This is common when you are in the 37-40 week of your pregnancy. PROM occurs in about 10% of all pregnancies. PPROM, preterm premature rupture of membranes occurs before 37 weeks. PPROM raises the risk of premature birth, and a higher risk of infection in the fetus or uterus. Premature birth can also cause complications with your baby’s respiratory system, or their ability to stay warm. PPROM occurs in about 3% of all pregnancies. It is more common in pregnancies of twins.

In some cases the rupture of membranes can happen due to the natural weakening of the membranes as the pregnancy continues. It can also occur if there is too much amniotic fluid, which puts too much pressure on the membranes causing them to rupture prematurely. Contractions can cause the rupture of membranes. Uterine infections, infections of the cervix, or infections of the vagina can also cause the amniotic sac to rupture. Other causes are sexually transmitted diseases, previous preterm births, vaginal bleeding, or smoking during pregnancy. In some cases the cause of PROM is unknown.

It can sometimes be hard to know if your water has broken during pregnancy. Especially if it happens early and you aren’t expecting it. In some cases it may feel like a gush of fluid from the vagina, that you cannot hold in. The fluid will be clear and odorless. Some people say they don’t experience the gush but they have a trickle or slow leak that makes their underwear constantly feel wet. Later in pregnancy vaginal discharge increases, as well as the need to urinate so trying to distinguish between those three things can be hard. If you are unsure it is best to speak with your healthcare provider soon after you think your water has broken so you can be treated appropriately.

If you suspect your water has broken but are unsure it is best to see your doctor. There are a few things they can do to diagnose what is happening. The first is to examine your cervix, they may be able to see fluid leaking from it. They can also take a sample of the fluid and test the pH of the fluid. They may also want to do an ultrasound to check the levels of amniotic fluid still surrounding the baby, and to make sure the baby isn’t in any distress.

Treatment is dependent on how far along you are in your pregnancy. Treatment usually consists of two options, one delivery or two expectant management which is delaying labor. If your membranes rupture between 37 and 40 weeks of pregnancy 90% of people will go into labor within 24 hours. If for some reason you do not, your doctor may induce your labor. If your membranes rupture between 34-37 weeks your doctor will want to weigh the risks of delivery versus the chance of infection. If you are closer to 37 weeks your doctor may decide to deliver your baby, knowing they may need some extra care from the NICU. If your membranes rupture before 34 weeks your doctor will want to try and delay delivery. The complications of premature birth are higher. Treatment for this may include bed rest, corticosteroids to help develop the baby’s lungs, antibiotics to ward off chances of infections, tocolytics to stop labor, and magnesium sulfate to help develop the baby’s brain. The goal of this treatment is to get you to 34 weeks so the preterm complications decrease. During this time mother and baby will be closely watched to make sure no one is in distress.

PROM can cause many complications. It can lead to premature birth. Infection of the placenta tissues. It can also cause placental abruption, which is when the placenta detaches early. Compression of the umbilical cord. PROM can lead to a c section delivery. It can also cause postpartum infections. There is no way to prevent PROM, or PPROM, or any way of knowing if it will happen to you.