Premature Rupture of The Membranes

Causes

Although the cause of PROM is unknown, malpresentation and contracted pelvis commonly accompany the rupture. Predisposing factors may include:

• poor nutrition and hygiene and lack of proper prenatal care
• incompetent cervix (perhaps as a result of abortions)
• increased intrauterine tension due to hydramnios or multiple pregnancies .
• defects in the amniochorial membranes' tensile strength
• uterine infection.

Signs and symptoms

Diagnosis

In addition to a complete medical history and physical examination, PROM may be diagnosed in several ways, including the following:

• an examination of the cervix (may show fluid leaking from the cervical opening)
• testing of the pH (acid or alkaline) of the fluid
• looking at the dried fluid under a microscope (may show a characteristic fern-like pattern)
• ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Treatment

Treatment for PROM depends on fetal age and the risk of infection. In a term pregnancy, if spontaneous labor and vaginal delivery aren't achieved within a relatively short time (usually within 24 hours after the membranes rupture), induction of labor with oxytocin is usually required; if induction fails, cesarean delivery is usually necessary. Cesarean hysterectomy is recommended with gross uterine infection.

Management of a pre-term pregnancy of less than 34 weeks is controversial. However, with advances in technology, a conservative approach to PROM has now been proven effective. With a preterm pregnancy of 28 to 34 weeks, treatment includes hospitalization and observation for signs of infection (maternal leukocytosis or fever, and fetal tachycardia) while awaiting fetal maturation. If clinical status suggests infection, baseline cultures and sensitivity tests are appropriate. If these tests confirm infection, labor must be induced, followed by I.V. administration of antibiotics. A culture should also be made of gastric aspirate or a swabbing from the infant's ear because antibiotic therapy may be indicated for the new-born as well. In such deliveries, have resuscitative equipment available to treat neonatal distress.

Prevention

Unfortunately, there is no way to actively prevent PROM. However, this condition does have a strong link with cigarette smoking and mothers should stop smoking as soon as possible.