Premature rupture of membranes (pPROM)

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Premature rupture of membranes

La spontaneous premature rupture of amniochorial membranes which contain the fetus typically occurs during the labor of childbirth or shortly before its onset. If the membranes rupture before term, that is before 37 weeks, we speak of preterm rupture of the membranes (pPROM). About 2 women out of 100 during pregnancy go through breaking of the waters preterm.

How to intervene in case of preterm rupture of the membranes?

In this article

• How do you recognize the breaking of the waters? 
• What to do in the event of a water break?
• What will happen in the hospital? 
• What caused the waters to break? 
• What happens to me and the baby?
• What treatments can I get?
• When can I go home?
• What can I and should I do at home?
• When should I be alarmed?
• What awaits me after a pPROM?

Read also: Breaking the waters in pregnancy

How do you recognize the breaking of the waters?

During rupture of the membranes, there is a loss of fluid with a wet sensation in the genital level. The fluid (known as amniotic fluid) is light or pink in color and may also be slightly bloodstained. The amount of liquid that can be seen can range from a modest drip to a major stream.

What to do in the event of a water break?

It is advisable to wear an external absorbent e monitor the color and odor of the fluid, as well as the extent of the loss. Sometimes the lost fluid is actually urine and during pregnancy it can be normal. Leakage of amniotic fluid smells different than urine. In the event of rupture of the membranes, however, it is advisable to go to the nearest hospital.

What will happen in the hospital?

In the hospital, you will be subjected to a careful check-up which will include:

• An interview with a gynecologist who will investigate whether pPROM had occurred in previous pregnancies (if this has happened, it is likely to also occur in subsequent pregnancies)
• An obstetrician-gynecological visit: the gynecologist will use a speculum to evaluate the uterine cervix and verify if the lost fluid is actually aminiotic fluid. The gynecologist will also assess whether the cervix is ​​undergoing changes in preparation for labor.
• A specific test performed on the leaked fluid to confirm rupture of the membranes.
•  A transabdominal ultrasound to check the amount of aminiotic fluid in the uterus and check the heartbeat of the fetus.

If only a small amount of amniotic fluid has been lost, it is not easy to confirm that the membranes have ruptured. If the breakup is not confirmed, you can go home. If you continue to leak fluid, you will need to go back to the hospital.

If the checks carried out confirm the breaking of the waters, you may be presented with the following:

• Hospitalization for close monitoring of fetal well-being and pregnancy, as well as the appearance of any symptoms and signs of childbirth
• Regular testing and monitoring for infections, including checking body temperature and heart rate
• Blood chemistry tests
• Performing vaginal swabs

What caused the waters to break?

For most women, the cause of the breaking of the waters is not known.
The fetus is surrounded by a sterile fluid contained within the amniotic sac. The vagina, on the other hand, is not a sterile environment and contains saprophytic bacterial flora found in all women. There is a connection between the breaking down of the water and the growth of a certain type of bacteria in the vagina: in fact these bacteria produce enzymes that can weaken the membranes that form the amniotic sac and cause it to rupture, allowing the amniotic fluid to escape.

It is certain that:

• Whatever you did didn't cause the waters to break
• Nothing could be done to prevent the breaking of the waters

Read also: Calculate the date of birth with Naegele's rule

What happens to me and the baby?

• Preterm spontaneous vaginal delivery
  A fair share of women go into labor between 24 and 48 hours after the waters break. The risk of this happening is greater when a genital infection is present.
  
  
  
• Infection
  The membranes that form the amniotic sac constitute a protective barrier around the baby and after their rupture there is a greater risk of bacteria and infections returning to the uterine level. When the infection reaches the inside of the uterus it can be a trigger for the onset of preterm labor.
  
  
  I symptoms of an infection can include:
  
  - rise in body temperature
  vaginal discharge with an unpleasant odor
  - increased maternal heart rate
  - abdominal pain of uterine origin
  - the baby's heartbeat faster than normal

• Pulmonary development
  The aminotic fluid that surrounds the baby is needed by the fetal lungs for their development. If the waters break very prematurely, there may not be enough fluid for the baby's lungs to develop normally. This happens especially in the case of very early rupture, before 24 weeks.
  
  
  
• Prematurity 
  Premature babies have a higher risk of health problems, especially type respiratory, alimentary and infectious. Babies born before 34 weeks tend to have a greater risk of severe problems, even those requiring hospitalization. neonatal intensive care. The problems are even greater when a baby is born before 28 weeks of pregnancy. These premature babies will be held for and needed care in the hospital.

What treatments can I get?

There is no treatment that can restore amniotic fluid or that it can repair the hole in the membranes of the amniotic sac: the baby's kidneys will continue to produce amniotic fluid even if the membranes are ruptured. In fact, you may lose aminotic fluid throughout your pregnancy. Currently it is possible to resort to the amnioinfusion procedure, that is, to increase the volume of amniotic fluid through amniocentesis and transfer of fluid to the uterus. However, this practice should be discussed with the gynecologist and is only proposed in the case of early pPROM (<26 weeks) since currently the evidence of benefit has not yet been well established.

Monitoring is needed to identify for signs of infection and to prepare the fetus for preterm birth.

You may be offered:

• An antibiotic treatment to treat or lower the risk of infections
• Administration of tocolytics to stop uterine contractions and thus reduce the risk of preterm birth

When can I go home?

If the membranes have ruptured, it may be necessary stay in the hospital until the baby is born in order to monitor for signs of infection and the well-being of the fetus.

What can I and should I do at home?

The gynecologist will inform you which ones they are the signs of infection in order to identify them. It's important:

• Check twice a day that the underarm temperature is normal (37 degrees)
• Check that the amniotic fluid you are losing does not change color or increase
• Avoid vaginal intercourse
  
  

T will also be required to come to the hospital cyclically to carry out checks such as:

• a blood sample to count leukocytes (cells that fight infections and increase during infections)
• a vaginal swab to identify vaginal flora harmful to pregnancy
• control of fetal heartbeat
• ultrasound check to visualize the amount of amniotic fluid present in the sac

When should I be alarmed?

Return to the osepdale immediately in the event of the appearance of signs of infection or labor Which:

• rise in temperature
• decrease in fetal movements
• flu symptoms
• vaginal bleeding
• abdominal pain
• uterine contractions

What awaits me after a pPROM?

The gynecologists who follow you during your pregnancy in the hospital will explain extensively what choices you have in front of you when diagnosed with premature rupture of membranes.

In fact, continuing the pregnancy increases the risk of infection but would still reduce the problems of fetal prematurity.

Based on the clinical situation, the choices are:

• continuous monitoring of your health and that of the fetus
• induction of labor and delivery between 34 and 37 weeks of pregnancy

Sources for this article:

Royal College of Obstetrics and Gynecology (RCOG) 

Civil Hospitals of Brescia

Mayo Clinic

Read also: How natural childbirth works, 5 things to know

Questions and answers

How to recognize the breaking of the waters?

The rupture of the water is accompanied by the leakage of the amniotic fluid previously contained in the sac of the same name. The liquid that comes out when the water breaks is a colorless, odorless and hot liquid.

How long does it take for labor to begin after the water breaks?  

Birth usually begins 12-24 hours after the water breaks. In general, if the breaking waters are clear, you can wait a little longer and take it slower. If, on the other hand, the waters are tinged with blood, it is better to move immediately.

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